CarolApp

A Mobile e-Health Software Project for Remote Monitoring of Children enrolled in

the Carolina Curriculum

Salvatore Cuomo

, Pasquale De Michele

, Francesco Piccialli

, Antonella Olivo

and Ennio Del Giudice

University of Naples “Federico II”, Department of Mathematics and Applications ”Renato Caccioppoli”, Naples, Italy

Fondazione Istituto Antoniano, Ercolano, Naples, Italy

University of Naples “Federico II”, Faculty of Medicine, Via Pansini, Naples, Italy

Keywords:

Mobile Technologies, Healthcare Applications, Health Care Management, Health Information Systems.

Abstract:

The Carolina Curriculum for Infants and Toddlers with Special Needs (CCITSN) is a well established assess-

ment curriculum-based for early intervention programs, where sequenced items data collection and analysis

allow for monitoring, incremental program change, and recognition of areas of relative strength and weakness

in children with mild, moderate, or severe disabilities. Unfortunately, this protocol, and the support developed

software C@rolin@, is concerned only with the medical aspects, which are basically recorded with a huge gap

of time intervals. Moreover, due to lack of funding in local health care facilities, the medical staff is not able to

care adequately the involved children that, as provided by this program, must perform most of the assessment

activities in their own homes, supported by parents that often are left alone during the period between two

medical visit. In order to reduce the gap between families and medical staff, this paper describes the design

and development of CarolApp, a mobile framework that allows, from one side, parents of enrolled children in

the Carolina Curriculum to capture situations by using collected photos and videos relating to the behaviors of

their children during the assessment period at home and to send these to the ad-hoc social network by means of

their mobile devices, and from the others side, medical staff to care adequately the patients in a “remote-way”,

analyzing and providing certiﬁed feedback, answers and if needed request an additional visit, by following the

progress of these children thanks to the received multimedia objects.

1 INTRODUCTION

The study of medical protocols for monitoring and

analyzing the cognitive development of children with

disabilities is a very spread out research area (Chap-

man and Hesketh, 2000). In this context, the Carolina

Curriculum for Infants and Toddlers with Special

Needs (CCITSN) (M. Nancy, 2014) is a well estab-

lished curriculum-based assessment for young chil-

dren with disabilities. Recently in Italy the Carolina

Curriculum has been adopted as a basic service

within several local Regional Service Systems (ASL)

(see (Del Giudice et al., 2006)). A full web applica-

tion software system, named Carolina, based on the

Carolina Curriculum protocol is available in (Cuomo

et al., 2011). This software allows, from one side, to

efﬁciently collect, represent, and evaluate the relative

data along the curriculum and, from the other side, to

support educators, doctors, parents, volunteers, thera-

pists, and the children themselves in the assessment-

intervention process of the children involved. Unfor-

tunately, the Carolina protocol, and so the software

developed in (Cuomo et al., 2011), takes care only

of the medical aspects, which are basically recorded

with a huge gap of time intervals.

Moreover, families and children cannot communicate,

ask questions and post experiences on the software.

Indeed, the missing of interaction makes the use of the

Carolina program less useful in practice. The major

difﬁculty that prevents a wide dissemination of this

medical protocol is the long time interval between a

medical visit and the next one. During this period, of

about four/six months, the enrolled child receives a

list of items (activities) that he has to improve through

speciﬁc practices; but although he’s constantly moni-

tored by his parents, in the majority of cases situations

that would require the medical intervention occurs.

To address this problem, we consider the applications,

473

Cuomo S., De Michele P., Piccialli F., Olivo A. and Del Giudice E..

CarolApp - A Mobile e-Health Software Project for Remote Monitoring of Children enrolled in the Carolina Curriculum.

DOI: 10.5220/0004911604730477

In Proceedings of the International Conference on Health Informatics (HEALTHINF-2014), pages 473-477

ISBN: 978-989-758-010-9

 2014 SCITEPRESS (Science and Technology Publications, Lda.)

services and tools that are web-based for health care

consumers, caregivers, patients, health professionals

and biomedical researchers.

The Social networking service embedded in the

Carolina software is a preliminary solution (Cuomo

et al., 2012); it involves the explicit modelling of con-

nections between people, forming a network of re-

lations, which in turn enables and facilitates collab-

oration and collaborative ﬁltering processes. In the

proposed framework, this service enables the fami-

lies enrolled in the Curriculum to ask assistance to

medical operator by means of messages, web con-

ference, etc.; moreover, it enables to see what their

peers or others with a predeﬁned relationship (“fam-

ilies friend”, “doctor”, “assistant operator”, etc.) are

doing in the same assessment; ﬁnally, it enables to

have supplementary medical advices on demand by

means of their smartphone. An increasing number

of healthcare professionals put into use smartphones’

applications that enable remote monitoring or health-

care management (Zorba et al., 2012). Moreover, lots

of patients already take advantage of m-health appli-

cations to improve and assist their own life and health.

According to this perspectives, this paper describes

the design and development of CarolApp, a mobile

framework that allows, from one side, parents of en-

rolled children in the Carolina Curriculum to capture

situations by using collected photos and videos relat-

ing to the behaviors of their children during the as-

sessment period at home and to send these to the ad-

hoc social network by means of their mobile devices,

and from the others side, medical staff to care ade-

quately the patients in a “remote-way”, analyzing and

providing certiﬁed feedback, answers and if needed

request an additional visit, by following the progress

of these children thanks to the received multimedia

objects. The outline of the paper is: Section 2 draws

some motivation and related work; in Section 3 we

describe the system framework; Section 4 explains a

ﬁrst experiment. Finally, in the Section 5 we give the

conclusions.

2 MOTIVATION AND RELATED

WORK

Familiarizing people with smart devices and the con-

stantly growing use of medical related mobile appli-

cations enables complete and systematic monitoring

of a series of chronic diseases both by health profes-

sionals and by patients. A large number of mobile

applications have already been developed to support

medical staff and to record and manage information

related to chronic diseases. Handheld devices have

been exploited in many cases to facilitate health ori-

ented procedures. M-health can be deﬁned as “mo-

bile computing, medical sensor, and communications

technologies for health-care”. This emerging concept

represents the evolution of e-health systems from tra-

ditional desktop “telemedicine” platforms to wireless

and mobile conﬁgurations (Altini et al., 2010). Devel-

opments in wireless communications integrated with

developments in pervasive and wearable technologies

will have a radical impact on future health-care deliv-

ery systems (Istepanian et al., 2004). Mobile appli-

cations 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).

Many consumers nowadays take advantage of m-

Health applications to improve their lives and assist

their health (Fox, 2010). Beneﬁts of m-Health Appli-

cations and Solutions are widely known and accepted.

Many existing applications meet the needs of individ-

ual 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 crit-

ical medical data and communicate with other appli-

cations in an effort to solve a health issue (Klug et al.,

2010). Data related to health records are often sent

to servers storing personal health record services or

directly to physicians (Boulos et al., 2011).

To better understand the motivations behind our work,

it is important to analyze the gap between the children

enrolled in the Carolina Curriculum and the medical

staff that should care them, throughout the period of

assessment at home. Provide the possibility for par-

ents of these children, to be assisted through a few

simple clicks on their mobile devices, during this pe-

riod, is a fundamental task. In fact, the guidelines of

this curricular protocol strongly recommend that the

child has to be constantly monitored during the course

of his daily activities at home, suggesting where nec-

essary correctives.

3 FRAMEWORK OVERVIEW

CarolApp is conceived to be a stand-alone applica-

tion, evaluated for iOS and Android platforms. Main

criteria used to develop CarolApp are: (i) operating

stand-alone on a mobile platform; (ii) increasing the

interactions between patients and medical operators

covering a wide range of speciﬁc topics. In the fol-

lowing, we highlight some important requirements, in

this case, were respected in the application develop-

HEALTHINF2014-InternationalConferenceonHealthInformatics

474

ment, namely:

• Medical Usability. The application should have

been easy to use for physicians. It should have

required minimal training and minimal mainte-

nance. It should have minimized power consump-

tion to avoid the inconvenience of recharging. It

should be portable so that all actors unrolled in the

assessment program can use the application any-

where they go and on several devices.

• Manageability. The application should be easy to

install, deploy, and maintain. It should have pro-

vided tools to assist solution to the clinical prob-

lem treated.

• Reliability. The application should have worked

speciﬁc security policies for preserving sensitive

informations stored in the web Carolina web ap-

plication.

The proposed framework design and implements an

architecture for enabling a remote support strongly

connected with the social networking healthcare plat-

form, by means of a mobile application that offering

the opportunity for parents to request medical sup-

port and feedbacks, during the assessment program

of their children at home. The overall information ob-

tained by the Carolina Curriculum therapy are elab-

orated by different software modules and the plan-

ning program in reported in Develop Progress Dia-

gram charts (see (Cuomo et al., 2011; ?)). We expand

the assistance due to the actors of this protocol with a

social network.

Taking some of the terminology from Carolina Cur-

riculum and mapping them to social networking, we

deﬁne the following terms:

Carolina Assessment Group: A group within a

buddy-list comprising of health-care professionals

and the patients.

Carolina Medical Group: A group within a

buddy-list comprising of health-care professionals

only.

Families Context: A group of families enrolled in

the Curriculum.

Supplementary service: Experts that sit in the

care groups offering predeﬁned services to the users

of the group.

Social Networking Services: Instant Messaging

(IM), Web Conferences, Posted Messages, Wiki, etc.

The following is an experimented scenario that shows

the integration of social networking terms into the

work of the Carolina community. In the Figure 1 we

report the use case diagram of the overall Carolina

framework. The Carolina web based features, named

Carolina Assessment, are integrated and extended

with the Social interactions in the green rectangle of

Figure 1: Use case Diagram.

the ﬁgure. All users can access to Carolina Assess-

ment, Social Interaction and Conference call system

modules. The Social Interaction is extended many

functionality options, as the possibility to share or

view video, photo, posts and media. In the proposed

software only power users, such as doctors or autho-

rized operators, are able to manage reserved data of

the Carolina medical protocol, reported in the yellow

chart of the use case diagram.

In this framework we have implemented new mod-

ules and services of the social networking without

changing the modular software infrastructure of the

Carolina Software (see (Cuomo et al., 2011)). In the

Figure 2 we report the graphical interface of the web

based social interaction module. Finally, in the next

section we reports preliminaries results.

4 A PRELIMINARY

EXPERIMENT

We test the alpha-version of the CarolApp with 5

medical operators that were involved in the care of

10 families (with children enrolled in the assessment

program). The families are split logically into care

groups associated with the age of patients. The pa-

tients within a ﬁxed age group have to develop the

right skills in accordance to the age. Here for brevity

we report an interaction that has taken place in the

Carolina Assessments program through CarolApp. A

patient performs (see Figure 3) some of the tasks as-

signed to him for the achievement of a certain skill.

The family have posted the event and had a feedback

CarolApp-AMobilee-HealthSoftwareProjectforRemoteMonitoringofChildrenenrolledintheCarolinaCurriculum

475

Figure 2: Web Based Social interaction module.

from the Doctors. Consequently, the family decides to

post a request for assistance in Carolina Call Confer-

ence to the Carolina Medical Group. A parent of the

children decides to activate and schedule on-line as-

sistance service through the web conference tool pro-

vided by CarolApp (see Figure 4).

In the meanwhile, the community starts to answer and

post advices on the Group of Families Context, so ex-

ploit the services offered by social networking.

According to the model showed, four ideas emerge

from the Social Network service applied to Carolina,

succinctly described in the following. The Participa-

tion of families, patients and medical operators that

became active actors of the medical assessment pro-

gram. The Openness of the system that permits to in-

dividuals and healthcare organizations to operate by

a communal management decision-making process.

The Collaboration between all enrolled people of the

curriculum that work all together to improving the pa-

tients development skills. Finally, the Communica-

tion that enables the efﬁcient exchange of experiences

and sharing emotional states. Our model is a multidi-

mensional scheme in which we have different levels

of interactions. Horizontal interactions between fam-

ilies and patients enrolled in the assessment. Vertical

communications between families and medical opera-

tors that work with Carolina. Each user of every group

has received a different level of training assessment.

Families and patients can be seen as experts and their

Figure 3: Carol App interaction: Share informations.

Figure 4: CarolApp Call Conference tab.

collective wisdom can and should be used. It is well

known that the health operator is an expert in identi-

fying disease, while the patients and families are ex-

perts in experiencing it. The Carolina framework has

a client tier, an application tier, and a data tier, work-

ing as follows: every single Regional Local Health

Department is connected to a Data Center in order to

store and manage the data of the medical protocol.

The Carolina portal and the Social Network represent

the two souls of the framework architecture, working

together in a virtuous way.

In the social networking service, a user-friendly

graphic interface (see Figure 3), allows the opera-

tors and families to easily share data among them,

have detailed information about scores and items of

the curriculum, monitor skills development along the

HEALTHINF2014-InternationalConferenceonHealthInformatics

476

time by means of system communication. Doctors,

patients and their families can share medical data as

well as personal experience and troubles, which turns

to be helpful both in the medical and emotional sides.

All these features guarantee that every child will have

a full assistance, corresponding to his speciﬁc needs.

5 CONCLUSIONS

In this paper we present CarolApp, an ongoing

e-health project for the CCITSN medical proto-

col, which extends the Carolina software with the

embedded Social networking service, implemented

in (Cuomo et al., 2011; Cuomo et al., 2012), by means

of the design and develop of a mobile application that

is able to collect texts, photos, and videos of real-

time situations of the child and to forward them to the

ad-hoc social network. The project is certainly am-

bitious, it aims to improve the health beneﬁts of the

Carolina curriculum thanks to an ad-hoc infrastruc-

ture that relies on the ICT technologies; the main goal

of the described framework is to reduce the govern-

ment spending decreasing gradually the unnecessary

clinic visits. Preliminary experimental results showed

the usability of our approach and encourages further

research. Future work will be devoted to ﬁnish the de-

ploy of the entire system in the next months and col-

lect more complete and interesting experimental re-

sults about the real advantages of the proposed frame-

work also considering the related costs and beneﬁts,

for example in terms of maintenance needs.

ACKNOWLEDGEMENTS

This paper is ﬁnancial supported by Associazione

Italiana per lo Studio delle Malformazioni (ASM)

Onlus under the grant “Infrastrutture informatiche di

supporto, monitoraggio ed analisi di dati per bambini

con malattie rare congenite e disabilit

a”.

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