The objective of this exploratory study was to develop and test a health data management innovation that linked multiple smart technology devices together and then integrate the data collected into one database. This health data management system has been developed as part of a study into a smart homes concept for individuals with severe mental illness residing in transitional hospital apartments. The study aims to pioneer smart technology solutions that will transform the way our health systems care for individuals experiencing mental illness by facilitating greater connectivity between patients and a diverse group of health care providers (HCPs) such as nurses, occupational therapists, social workers and psychiatrists to strengthen the therapeutic relationship.
Methods:
The health data management system has been comprised of two software innovations; the Lawson Integrated DataBase (LIDB) and the Collaborative Health Record (CHR). The LIDB is an information management platform that collates and manages client health information. The LIDB keeps health data segregated in its own database schema but is capable of matching patient data across HCPs. Data was linked to the correct patient based on the time and date they were admitted/discharged from the smart apartment. The security of the LIDB has been tested and ensured through a third-party Privacy Impact Assessment and Threat Risk Assessment.
The CHR allows for both synchronous and asynchronous communication between patients and HCPs to deliver team-based, longitudinal health care. The specific functions of the CHR include: 1) access to personal health information and self-assessments to enhance early identification of concerns related to symptoms; 2) a comprehensive patient-record system that provides workflows for HCPs; 3) prompts and reminders that can support care planning for symptoms and comorbidities (e.g., medication reminders and activity prompts); and 4) secure communication between HCPs and patients, including videoconferencing. Barriers to health care such as inadequate travel arrangements, long wait times, and lack of resources (Dyck & Hardy, 2013), as well as reducing the number of in-person appointments may be overcome by the CHR’s functions. Data from validated assessments within the CHR such as PHQ9 and fully customizable questionnaires are completed by the client and then sent to the HCP. The data from these assessments were then backed up to the LIDB and added to the patient’s profile. This therefore allows the HCP to monitor changes and potential crises. The CHR has previously been evaluated by the research team using tablet devices (Forchuk et al., 2016), but will be extended in the current project to other types of devices such as smartphones, touch-screen monitors and existing Smart TVs in the apartment. Patients were offered the choice which of these devices they would like to have to access the CHR software and receive communication from the LIDB.
A variety of tools are required for the diverse needs of patients. In addition to the screen devices, wireless-enabled health monitoring devices was provided including weight scales, blood pressure monitors, glucometers and a heart rate activity tracker. These devices account for comorbidities that may be present among patients and will support chronic illness management. Previous research has reported increased mortality rates among individuals with severe mental illness due to a lack of effective acute and chronic illness management (Walker, McGee, & Druss, 2015). The connectivity of these health monitoring devices with the screen devices was established through Bluetooth. The health monitoring data was backed up to their respective Clouds via encrypted authentication keys and SSL connectivity to ensure secure data transmission. The data stored in the Clouds will then be exported into the LIDB for HCPs to view. A secure log-in portal allowed HCPs to monitor and track any irregularities in the patient’s health data and self-assessments therefore allowing them to respond accordingly. The LIDB is able to use the data and information from treatment plans to push notifications in the form of prompts and reminders via SMS text-messaging. The prompts sent to the patient will remind them to attend appointments, take medications, and complete treatment plan activities (e.g. exercise, therapy, etc.).
Results:
Developing safe secure prototype apartments is a crucial step before widespread use in the community. As is the case with new technological innovations, the intervention needs to ensure the security and privacy of participants and their data. Monthly meetings have been held with the Information Technology department and the hospital privacy department as it has been critical to review the appropriateness of each device and in the context of the system as a whole. Many smart devices for the home do not meet the security or privacy requirements of the health café system or the compatibility requirements to connect with the other selected smart devices or our data system. For example, six different fitness trackers were reviewed before one met the security and compatibility criteria to be added to the intervention. Furthermore, the touch-screen monitor was developed in-house by the research team’s programmer and therefore needed to be programmed with an operating system that was compatible with the devices and apps available on the market. This exhaustive innovation therefore adopted smart technology devices and custom-built equipment to be connected together and to our own existing hospital database through careful reviewing of devices and extensive programming.
Conclusion:
The implications of this development could be wide-reaching in that it could transform the way in which mental health care is delivered. Furthermore, this study could enable mental health care strategies and inform health policy and decision-makers to adopt more smart technologies into mental health care and/or treatment plans. It is envisaged that this project will provide information to enhance the system before wider-scale adoption in the community. It is also anticipated that the long-term implications of this system will help to effectively serve more individuals with mental illness, provide greater support for patients transitioning back into the community, decreasing health service utilization, and preventing re-hospitalization.