Home Health Smart TV
Bringing E-Health Closer to Elders
Leon Dragić
1
, Igor Piljić
1
, Mario Kovač
1
, Hrvoje Mlinarić
1
, Petar Franček
1
,
Martin Žagar
1
, Vlado Sruk
1
and Darko Gvozdanović
2
1
Faculty of Electrical Enginnering and Computing, Zagreb, Croatia
2
Ericsson Nikola Tesla d.d. Krapinska 45, Zagreb, Croatia
Keywords: E-Health, Smart TV, Social network, Elders, Healthcare
Abstract: In this paper we present the novel platform for accessing multimedia e-health content adapted for elders. ICT
solutions offered on market today are not adapted to elder people. Home Health Smart TV was developed in
order to solve this issue. Integration with social network features, like video communication and personalized
calendar, solves another concern for elder population - social isolation. Elder population is accustomed to
TV devices and with this specially designed platform they can access their medical data and communicate
with friends, family or medical staff in a simple way that doesn’t require computer literacy.
1 INTRODUCTION
An aging population has become a demographic trend
of the majority of developed societies (R. Moody,
2006). Due to this trend, it is a known fact that
healthcare costs could double among EU member
states by 2060 (Kovač, 2014). This problem is
addressed in the European Commission’s eHealth
Action Plan 2012-2020 (EHealth Action Plan, 2012)
which states that ICT solutions should be applied to
health and healthcare systems to increase their
efficiency, improve quality of life and unlock
innovation in health markets.
From 2007 to 2013 percentage of the individuals
aged between 16 and 75 who used the internet for
seeking health-related information in EU increased
from 24 to 44% (Eurostat). This trend shows that
people are willing to actively participate in decisions
that concern their medical condition and active
participation is connected with better health outcomes
(Heisler, 2015).
Access to medical data for patients is often
provided through patient portals. These solutions,
although useful for some patients, require substantial
technical knowledge which makes them unusable for
elder patients with low computer literacy (Lober,
2006).
Another problem that is of particular concern for
older people is social isolation. (Ages, 2013). Finding
ways to support people to make and maintain social
connections should be a priority for public health
particularly in the area of aged care. As such, older
adults are potentially at greater risk of becoming
socially isolated, and of experiencing the negative
health consequences of this. In order to bring ICT
solutions closer to elder population it is necessary to
address barriers to technology adoption and
consequently develop well-designed system that can
be used even if the end user is technically illiterate
(Independent Age, 2015).
In this paper we present a novel platform “Home
Health Smart TV” specifically designed for older
people. Using this platform, older people can access
their medical data, education materials, history of
medical measurements and other medical related
information. The platform also addresses problem of
social isolation for older people and provides video
communication between different users. This way
patients can easily communicate with their friends,
family and/or medical staff.
116
DragiÄ
˘
G L., PiljiÄ
˘
G I., Kovac M., Mlinaric H., FranÄ ek P., Å¡agar M., Sruk V. and GVOZDANOVIC D.
Home Health Smart TV - Bringing E-Health Closer to Elders.
DOI: 10.5220/0005890401160121
In Proceedings of the Fourth International Conference on Telecommunications and Remote Sensing (ICTRS 2015), pages 116-121
ISBN: 978-989-758-152-6
Copyright
c
 2015 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved

In order to minimize the certain fear that older
people tend to have regarding technology, the
platform is developed for the device older people are
familiar with – TV.
2 HOME HEALTH SMART TV
Even though they are technically illiterate, elder
people are using TV on daily basis. Studies showed
that adults aged > 65 years spent threefold more
waking time watching TV than young adults (Depp,
2010). Elder people are interested in their medical
conditions but are unable to access that information
because technical knowledge is prerequisite (Leist,
2013). Instead of adapting elders to ICT, ICT should
be adapted to elders. As a result, Home Health Smart
TV platform was developed on Faculty of Electrical
Engineering and Computing in Zagreb. Home Health
Smart TV is simple-to-use home system, connected
to the TV that overcomes the barriers, offers
improvement of patient’s health care quality and
enables easy access to information and data shared
between patient and healthcare providers.
Proposed platform addresses two main issues
explained in the introduction of this paper.
Consequently, the platform can be logically divided
into two main domains:
1) E-health domain
2) Social network domain
In e-health domain, Home Health Smart TV acts
as a patient portal for accessing medical data using
TV device. It connects to different e-health service
providers, retrieves the data, filters it and presents it
to the patient.
In social network domain Home Health Smart TV
enables direct message and video communication
between different users in the system. Patient can
navigate through the contact list and initiate or join
video call. Video and message communication can be
used for everyday communication between patient
and family but also for communication with medical
staff.
2.1 E-Health domain
2.1.1 Platform
Home Health Smart TV is carefully designed package
of Android applications deployed on specific Android
device. The package consists of 3 applications:
 Home Health Smart TV application
 Auto Update application
 Home Health Smart TV Launcher
Home Health Smart TV application is core part of
the Home Health system. It is used for accessing and
displaying patient medical data, playing various
multimedia educational content, message
communication between patients and health-care
professionals, etc. The medical information that is
showed to the patient is carefully picked by medical
experts. Piling too much information can be
counterproductive and make the important
information less visible, so it is important to filter the
most important data before displaying it to user.
Home Health Smart TV application is divided in
5 fragments:
 Home
 Messages
 Education
 Measurements data
 Social networking
Home fragment is used for providing general
information to the patient. Patient can check
information about the doctor, read the weather report
and check if there is any new message in his mailbox.
Message fragment is used for reading received
messages from healthcare experts. In the current
version, patients cannot reply to the received
messages but in future version, set of predefined
answers will be available for patient to select. These
kind of message exchange can be used for
cancellation of appointments or requesting new e-
prescription from doctor.
Education fragment is used for browsing
educational content stored on the device and
displaying the selected content to user. Education
material is categorized by types of illnesses which
helps patient to focus on specific problem. Education
material can be in a form of video, text, photo or
presentation. In the future, educational material can
be stored on remote server and patients could access
it through the internet.
Measurements fragment shows medical
measurements displayed as timeline chart. Medical
measurements are displayed in a period of 1 year.
This way patients can see the progress they are
making by regularly exercising, following diets and
advices from medical staff which is a great way to
empower and motivate the patients. Without having
graphical representation of the progress patients can
have difficulties to feel any improvements in their
medical condition which results in demotivation and
thus quitting the regular healthy routines.
Home Health Smart TV
Bringing E-Health Closer to Elders
117

Social networking fragment shows the list of
contacts user can interact with. Every contact is
represented by name, relationship to the user (family,
friend, nurse, etc.) and network status (online,
offline). Using this fragment, patient can establish
video communication with any contact that is online
or leave a notification to offline user.
The main application is accompanied with 2 more
extensions: Autoupdate Application and Home
Health Smart TV Launcher. Autoupdate application,
as the name suggests, is used for automatic update of
the application without any user input. The
application checks the application version deployed
on the server. If there is a new version deployed on
the server, the Autoupdate application will fetch and
install it without any intervention of user. Usual
solutions for updating the application, such as Google
Play service, can’t be applied for Home Health Smart
TV platform because updating of the application must
occur even if the application is executing. This way
we ensure that the latest version of the application is
installed on every active device which is very
important for users without technical knowledge.
The last application from Home Health Smart TV
platform is Home Health Smart TV Launcher. Smart
TV Launcher is used as default Android Launcher.
Using this custom launcher, we ensure that users
cannot exit the Home Health Smart TV application.
Making Smart TV Launcher as a default Android
Launcher will also provide us automatic start of the
application after the boot process.
2.1.2 Design
Primary requirements for application designed for
elders is simple design, intuitive navigation, filtered
content and user interface adapted to overcome the
lack of computer literacy and the physical barriers
such as visual impairment. The main input device
inside the application is remote control. In order to
simplify use of remote control, most of the buttons
were disabled, leaving only 8 buttons functional.
Navigation within the application is pretty
intuitive. Navigation bar is located at the bottom of
the screen. The title located in the middle is the title
of currently shown fragment. The titles on the left and
the right of the navigation bar show which fragment
will be displayed to the user if matching navigation
button is clicked.
2.1.3 Integration with e-health service
The application is connected to Ericsson Mobile
Health which provides patients personal medical data
through Medical node REST API. The
interoperability is a great challenge (Vida, Lupse,
Stoicu-Tivadar, 2012) when it comes to e-health
services. Market is filled with various e-health
solutions from different service providers. In order to
make the Home Health Smart TV platform adaptable
for different environments and e-health services, a
special focus is put in adding the module for
processing HL7 CCD standard for medical data
exchange. The Continuity of Care Document (CCD)
is a joint effort of HL7 International and ASTM (HL7
CCD). CCD fosters interoperability of clinical data
by allowing physicians to send electronic medical
information to other providers without loss of
meaning and enabling improvement of patient care.
CCD establishes a rich set of templates representing
the typical sections of a summary record, and
expresses these templates as constraints on CDA.
These same templates for vital signs, family history,
plan of care, and so on can then be reused in other
CDA document types, establishing interoperability
across a wide range of clinical use cases.
The platform makes periodic requests to the
adapter service which then polls the REST APIs of
different service providers. Adapter service is used
for adapting internal methods to various external
APIs. The communication process is secured using
HTTPS protocol. During the first boot and
initialization of the device, user enters his credentials
for e-health services he is using. The credentials are
then locally stored using AccountManager class.
Entering passwords using remote control is a very
difficult and time taking process, so instead of
entering passwords on every device boot, patients can
secure the access to their medical information using
PIN which they can enter after the device
initialization. PIN is not mandatory because
memorizing it can be an issue to elder people and can
be a reason for ceasing the use of the service.
2.1.4 Customizing Android ROM
Even after integrating all previously mentioned
modifications, users still need to configure Android
OS settings to be able to use Home Health Smart TV
platform properly. Although these are minor
adjustments, they still require technical knowledge
that elder people don’t possess. Since the goal of this
project is to make platform that is fully adapted to the
needs of elder people, Android ROM had to be
customized. Default Android ROM is filled with
different applications which are not necessary for
functioning of Home Health Smart TV. On the other
hand all those applications can interfere with normal
functioning of the application. All the applications
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that are not needed for normal functioning of the
system were removed. The buttons that are not used
inside the application were disabled. The script that
executes on first boot of the device was modified with
methods for configuring the device settings such as
Wi-Fi configuration, time zone configuration, default
launcher selection, etc.
2.1.5 Devices
Home Health Smart TV is bundled with 2 devices:
Android Set-top box for executing the Home Health
Smart TV platform and Wi-Fi 3G Router for internet
connection.
Android device was chosen for its ability to
connect to different types of TVs. Newer TVs can be
connected to the device using HDMI and the older
ones can connect using composite video interface.
The device is equipped with web camera which will
be used in future upgrades of the platform as a way
for direct video communication between different
stakeholders. Customized Android ROM contains the
information about Wi-Fi Router which enables
internet access without any additional configuration
of the Android OS.
2.2 Social network domain
In a modern society, where social media has altered
the basic rules of communication, gap between
generations is largely caused by different perception
of technology. Main issue of today’s communication
solutions, such as social networks, smart phones and
applications, is that they are adapted to younger
population and require technical knowledge. This
phenomenon is known as digital divide and is topic of
numerous researches done in past years (Norris,
2001) (Broos, Roe, 2006) (Vie 2008).
Statistics show significant difference in
percentage between age groups of people that use
internet to connect to social networks. While 85% of
people between the age of 16 and 25, and 52% of
people aged between 25 and 54 used internet to
connect to social network in 2014, only 16% of
people older than 55 did the same (Eurostat).
Since elder patients are major part of healthcare in
every country, integration of e-health with social
network has multiple benefits; displaying chosen
medical content to patients over internet saves money
and time to medical staff, while enriching e-health
system with some features that users can find
interesting and useful increases usage of the system,
but ultimately end user/patient is the one who benefits
the most.
2.2.1 Design
Designing social network that doesn’t depend on
platform is imperative. This way younger population
can use smart phones or PC’s to access the
application, while elders can use TV platform. User
interface must provide easy navigation and optimal
viewing experience across wide range of devices.
Most applications address this issue with responsive
web design, which solves the problem of displaying
content on different screen sizes, but adaptation to TV
platform, where remote control is main input device,
is more challenging.
One of the challenges is how to provide content
that will attract both, younger and older. Since the
final goal is to resocialize elders and make them use
modern technologies for communication with their
beloved ones focus is set on satisfying their needs, but
in order to foster communication between generations
younger population must find this application usable
as well. Establishing video communication between
parties regardless of device type and location is one
of the most important built-in functionalities. This is
accomplished via high quality communication
library. Although it is possible to connect with other
users by manually adding them to your network,
smart grouping system is applied to facilitate
interconnection. Different characteristics, like
geographic location, affiliation to certain
organization or similar interests, can be used to form
a group. Users within a group can chat, share files or
make a conference video calls. Personalized calendar
for appointments and reminders with external data
import support enables easy time tracking. These
features along with messaging and news services,
unavoidable options for any social network, form the
basis of a desired virtual society.
2.2.2 Video communication
Video communication is the cornerstone of
introduced social network. It is used for sharing live
video and audio streams between two or more actors
in the system. By introducing different roles in the
system, video communication becomes even more
powerful tool. Everyday communication with family
and friends can be extended to remote consultations
with medical personnel or social services, remote
diagnosis, second opinion, remote consultations and
therapies to multiple patients at same time and more.
Patients can also join different groups, depending
on their medical condition where they can share
experiences and advices. It is important to establish
community where patients will interact on daily basis
and support each other in dealing with their diseases.
Home Health Smart TV
Bringing E-Health Closer to Elders
119

Figure 2 shows example of establishing video
conference between patient, his doctor and one of his
family members.
2.2.3 Personalized calendar
Following therapies accurately is essential and in a
case where there are several therapies prescribed,
tracking them can present a challenge, especially for
elder patients that tend to be forgetful. The same is
true for doctor’s appointments that can be scheduled
months in advance and patients have to take a note of
that.
To enable easy time tracking interactive
personalized calendar is available. Every doctor’s
appointment or therapy is imported in calendar
automatically and reminder is triggered before each
event.
Some simple processes, like extending continuous
therapy, can be very time consuming for both, patient
and medical staff. To avoid this problem additional
feature is added so the communication between
medical staff and patient can be established via
calendar.
Extending continuous therapy via calendar is
done in four steps:
 Patient chooses therapy he wants to extend
 Medical staff receives request and process it
 Patient is notified after the decision has been
made
 If extending continuous therapy is approved
calendar is automatically updated and
prescription is issued
2.3 Pilot
Home Health Smart TV platform will be tested in
pilot project. 50 elder patients that are suffering from
at least 2 chronic diseases are included in pilot from
which 20 will receive the Home Health Smart TV
platform while others will receive mobile device for
accessing their medical data. Pilot project will last for
16 months. For this purpose, special service for
statistical analysis was developed and deployed on
server. Server will receive information about every
action users have made. After the 16 months, a lot of
valuable data will be gathered from which we will be
able to conclude in which direction future work needs
to be focused.
3 CONCLUSION
E-health systems and services offer an important
complement to routine clinical care. They have
become a necessity in most countries and the result is
health market filled with numerous ICT solutions.
Many of these solutions offer patients access to their
medical data through patient portals but the use of
these services requires technical knowledge and
therefore they are not adapted for elder population.
Finding ways to support people to make and maintain
social connections should be a priority for public
health particularly in the area of aged care. Even
though social networks are not complex applications,
accessing them can represent a challenge for elders
because they require platform-specific knowledge.
The solution for these problems is adapting ICT to
elders and not vice-versa. A platform was developed
on Faculty of Electrical Engineering and Computing
in Zagreb in order to address this issue. Home Health
Smart TV is simple-to-use home system, connected
to the TV that overcomes the barriers and offers
improvement of patient’s health care quality and
enables easy access to information and data shared
between patient and healthcare providers. Integration
with social network and introduction of new features,
such as video communication and personalized
calendar, increases usability and functionality of the
system and thereby improves well-being of the
patient. The functionality of the platform will be
tested in the pilot project which will last 16 months
and will gather valuable information about the usage
of the platform. The information will then be used as
guidelines for future work on this project.
Figure 1: Establishing video communication
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120

ACKNOWLEDGEMENTS
The research leading to these results has received
funding from the project "Information and
communication technology for generic and energy-
efficient communication solutions with application in
e-/m-health (ICTGEN)" co-financed by the European
Union from the European Regional Development
Fund and from project “Carewell - Multi-level
integration for patients with complex needs” co-
funded by the European Commission within the ICT
Policy Support Programme of the Competitiveness
and Innovation Framework Programme (CIP).
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