AAL Information based Services and Care Integration

Alexandra Queirós

, Sandro Carvalho

, João Pavão

and Nelson Pacheco da Rocha

Health Sciences School, IEETA,University of Aveiro, Campo Universitário de Santiago, Aveiro, Portugal

Escola de Ciências e Tecnologia, Universidade de Trás-os-Montes e Alto Douro,

Quinta de Prados, Vila Real, Portugal

Keywords: Ambient Assisted Living, Integrated Care, Personalized Care, Electronic Health Record, Personal Health

Record, Social Health Record.

Abstract: Health and social care systems are currently faced with a set of challenges that continually require more

sophisticated responses. The integration of health, social and informal care and the care personalization are

important issues in the organization of the care systems. This article aims to propose an information

architecture for Ambient Assisted Living (AAL) environments that can contribute to integrated and

personalized care.

1 INTRODUCTION

Information Technologies (IT) in health care have

gained widespread usage. IT benefits include

availability and accessibility of vital information,

more effective and efficient treatments, reduction of

the number of redundant procedures, lower risks for

the patients, greater cost savings and, therefore,

improved quality of care. In individual terms, IT

based services empower the citizens to exercise

control over their own health, by facilitating them

the access to knowledge and adequate services and,

consequently, allowing informed choices within the

available options.

This paper discusses the possible contribution of

Ambient Assisted Living (AAL) in the integration

and personalization of care services. The paper also

presents an information architecture able to integrate

both user-generated and AAL services-generated

data with institutional health and social care

repositories of information.

2 CHALLENGES

The challenges faced today by health and social care

systems are theirs sustainability: with public budgets

at strain the systems can not afford to do less

because demands and expectations are increasing,

namely due to the demographic ageing. Therefore,

both effectiveness and efficiency of the care systems

should be increased (Codagnone, 2009).

Given the current pressure resulting from the

cost of the health and social care systems, the

interactions between different care organizations

have gained significant relevance (Dias and Queirós,

2010): the availability of effective and efficient care

services requires the involvement and coordination

of multiple stakeholders. Therefore, the care systems

must guarantee to the citizens’ access to the type and

intensity of care they actually need at the most

appropriate time and place, depending on their

specific situation. This is the aim of integrated care,

which can contribute to a more personalized care

and that must not be confused with continued care.

Continued care generally presumes that care is

provided for long periods of time and that there are

services that are delivered in addition to those ones

which are provided within the walls of the care

organizations. The provision of continued care

requires the involvement of a diversity of

professionals and organizations and the existence of

coordination mechanisms, generally in the context of

multidisciplinary team work (Dias and Queirós,

2010).

The provision of health care services is based on

scientifically optimized standard procedures oriented

to diagnosis-based needs and centred on diseases

(Rigby, 2012). However, there are a range of

activities that are essential for the maintenance of

individuals’ quality of life and that are part of the

normal living of every citizen. Such activities

include daily life activities (e.g. tasks at home,

403

Queirós A., Carvalho S., Pavão J. and Pacheco da Rocha N..

AAL Information based Services and Care Integration.

DOI: 10.5220/0004326004030406

In Proceedings of the International Conference on Health Informatics (HEALTHINF-2013), pages 403-406

ISBN: 978-989-8565-37-2

 2013 SCITEPRESS (Science and Technology Publications, Lda.)

mobility, recreation or safety) and social

participation.

The clients of home care services can range from

persons with complex needs (e.g. 24 hours support)

to those who only need help occasionally with

relatively simple tasks (e.g. domiciliary support to

some activities of daily living). Therefore, home

care comprises a broad range of services, such as

rehabilitation, supportive and technical nursing care,

domestic aid, personal care or support to informal

caregivers.

To adequately meet the new demand patterns,

while ensuring equal access and care with sufficient

resources, the health and social systems need to

promote further decentralisation, shared

responsibilities and increased integration levels of

the provided services. This discussion is urgent in

order to optimize both effectiveness and efficiency

of the health and social care systems (Dias and

Queirós, 2010).

Since the purpose of integrated care is to achieve

a care that is less oriented by supply and focused on

the actual needs of the citizen, it can contribute to

the personalization of the services. The concept of

personalized care can be understood as the

individually customization of diagnosis and therapy.

Personalized care can also mean the empowerment

of the common citizen, allowing him or her to be

actively evolved in his or her health and care

pathway. This may contribute to the overall quality

of the care services provision and its effectiveness

and efficiency.

3 TECHNOLOGICAL SUPPORT

Within the contexts of continued care, integrated

care and personalized care, the existence of eHealth

services is essential to provide a better resources

allocation management, in accordance with the

citizens’ needs and those of the organizations

providing care services, considering its different

levels (Dias and Queirós, 2010).

Although there are many different concepts

associated to eHealth (Eysenbach, 2001), it can be

understood as the individualised provision of care

services independent of the time these services are

delivered as well as the physical location of actors

and resources involved in the care process (Blobel,

2010). It is commonly accepted that eHealth can

contributed both to the sustainability of health and

social care systems, and the empowerment of the

citizens. The eHealth paradigm promotes an easy

access to the existing resources and the knowledge

sharing whenever and wherever is necessary. The

existence of electronic records emphasizes the

citizens centred care, improves the prevention,

reduces the information redundancy, facilitates the

exchange and sharing of information among the care

providers (because electronic information can be

consulted starting from any point by properly

authorized users) and reduces the probability of

errors in adverse situations, through the access to the

complete patient record and the use of decision

support systems. Nowadays, the essential electronic

information associated with care providing is

distributed by Electronic Health Records (EHR),

Electronic Social Records (ESR) and Personal

Health Records (PHR).

The usage of EHR information can be

categorized as either primary or secondary: primary

use is associated with encounters between patients

and health care professionals, and secondary use is

related with education, research and development,

regulation and policy making.

The exchange and sharing of information

requires the existence of interoperable protocols.

This interoperability should facilitate the transfer of

information automatically between different care

sites. However, despite all the developments in

terms of systems interconnection and

interoperability protocols, the semantic

heterogeneity of the information remains a difficult

problem to solve, even if only EHR are considered.

ESR and PHR introduce additional interoperability

issues.

To address the EHR semantic interoperability

issue, there are several standards currently under

development aiming to structure and mark-up the

clinical content for the purpose of its exchange and

sharing. However, it is still difficult to foresee a

common agreement. In parallel with the

developments of the HL7 (e.g. RIM or Clinical

Document Architecture - CDA), the European

Committee for Standardization - Technical

Committee 251 (CEN/TC 251) is being defining the

EHRcom, which includes the OpenEHR Archetype

methodology to support the interoperability of

systems and components interacting with EHR

services (Katehakis et al., 2006).

Considering the importance of the integration of

health and social care services, the definition and

implementation of ESR have been considered during

the last years (SCDH, 2004). ESR should be

composed by various types of information, namely,

forms (e.g. nationally used forms or local assessment

forms), coded data (mainly for management and

statistical reporting purposes) or unstructured

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information covering all other recording, including

those ones originated outside the organization (e.g.

letters, emails or notes of meetings).

Since the service models employed by health

care providers and social care providers are different

there are important differences between EHR and

ESR: healthcare records are focused on a single

patient, often with considerable details and depth,

and the confidentiality of the individual is strongly

protected, while social care records, on the other

end, place the individual in their daily living context

of family and other informal carers, including the

attitudes and effects on each, so as to ensure mental

support and understanding (Rigby, 2012).

Since the empowerment of each citizen also

means that he or she should be able to contribute

with documentation, namely observations of his or

her daily living (Bos, 2012), PHR have, nowadays,

an increasing importance. They include data and

information related with the individuals’ lifetime

and individuals’ care maintain by each individual.

Furthermore, PHR can represent more than a

repository for the individual data, because they are

able to combine data, information, knowledge and

tools to help any individual to be proactive in their

own care (Schloeffel, 2003). This stands in contrast

with EHR, which are operated by organizations and

contains data entered by professionals.

The information on a PHR might include patient-

reported outcome data, laboratory results, and data

from a broad range of devices. For instance,

important data sources are wearable remote

monitoring systems with sensors to capture

physiological parameters such as electrocardiogram

(ECG), blood pressure, body temperature or heart

rate. These devices are particularly important for

home care and are one of the research investments of

the promising AAL developments (Queirós et al.,

2012).

4 CONCEPT

The AAL environments can increase or maintain the

individuals’ performance in a broad spectrum of

activities and participation. Furthermore, AAL

systems should acquire context information and

combine multiple sources of information and make

pattern-based predictions to be able to track the

individuals (e.g. localization, activities or

behaviours).

Another range of AAL services are related with

biomedical devices that can be implemented and

used both in clinical settings and in persons’ home,

smoothing the transition between both environments

(Blobel, 2010).

Since information is a requisite for high quality

care services and also for the empowerment of the

citizens’, the potential of AAL services can be

increased, if there is the possibility to create the

conditions to integrate both user-generated data and

AAL services-generated data with institutional EHR

and ESR, so that care can be more integrated,

personalized and useful for citizens. Consequently,

there is the need that AAL infrastructures should

support information architectures that enable the

creation and maintenance of information objects,

according to the requirements and needs of a wide

range of users and care providers.

Due to the difficult to accommodate the

development of new applications in poor structured

contexts (Heeks, 2006), open management

information paradigms (Yli-Hietanen and Niiranen,

2008) are required with robust and stable domain

models separated from the implementations and able

to specific adaptation. In this respect, we argue that

AAL information architectures should follow an

open management information paradigm, with two

modelling levels for the information structure: the

information model and the knowledge model.

The first level, the information model, embraces

all data types that are required to record the pertinent

information. It is the fundamental model required for

the technical implementation and, therefore, must be

stable over time in order to be maintainable. On the

other end, in the second level, the knowledge model,

domain and application specific concepts are

modelled (archetypes) with constraint rules to

specialize the underlying information model.

According to this approach, archetypes are instances

of an object oriented system implementation, which

means they can be created and manipulated by

adequate tools and alter as desired, without changing

the underlying information technical specifications.

The concept was validated by defining a data

repository (i.e. the information model), accordingly

to HL7 RIM and a set of functions for the

management of the archetypes, in order to shape the

HL7 RIM to specific application domains (i.e. the

knowledge model).

For the specification of the data repository we

select the HL7 RIM. Thus, data repository is

characterized by being a generic container and it is

necessary to evaluate whether this container is

adequate to accommodate all information objects

that can be associated with AAL services.

The followed validation procedure consisted in

the creation of scenarios, emphasizing not only the

AALInformationbasedServicesandCareIntegration

405

use of EHR but also the use of ESR and PHR, and in

the verification if all the information objects

required by these scenarios were supported by the

architecture.

In what respects PHR, it was considered the

implementation of a PHR application with a specific

interface to contribute with documentation related

with observations of daily living, namely, nutritional

and physical activities. The basic PHR structure was

based in the Health Information Form for Adults of

the American Health Information Management

Association (AHIMA) and the required archetypes

are compatible with the generic data container.

The ESR specification considered the

requirements of supporting all the information that is

essential for the care providing, reflecting on

different organizational levels and different types of

processes, namely in respect to observations,

reasoning or intentions.

The validation has shown that the generic data

container can support information structures not

only of EHR but also of PHR and ESR. The created

archetypes are compatible with the data container

and allow answering six basic questions linked to

each record: what, when, where, who, why and how.

Therefore, the information architecture is able to

integrate both user-generated and AAL services-

generated data with institutional health and social

care repositories and presents adequate models to

organize the information according to the

requirements of care services.

5 CONCLUSIONS

The AAL systems ability to acquire and combine

multiple sources of information to track the

individual’s activities and behaviours must be

considered in terms of the provision of health and

social care.

Therefore, it is required information architectures

able to accommodate a wide range of information

objects within the AAL environments. The proposed

architecture follows an open management

information paradigm, where the knowledge model

adjusts the information model to the requirements of

each specific domain application, which can

contribute to the integration of EHR, ESR and PHR.

ACKNOWLEDGEMENTS

This work was supported by COMPETE - Sistema

de Incentivos à Investigação e Desenvolvimento

Tecnológico, Projectos de I&DT Empresas em co-

promoção, under QREN TICE.Healthy.

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