At the Intersection of Research and Innovation

Get Updated on the Largest Nordic Research and Development Project on Healthcare Technology AT THE INTERSECTION OF RESEARCH AND INNOVATION Publisher: Patient@home Issue: 2000 Editor: Anders Lyck Fogh-Schultz, Layout: kreativgrafisk.dk Danish Technological Institute Print: Jørn Thomsen Elbo

Photo: Emil Ryge

2 patient@home CONTENTS

 Foreword ...... 4  Grant Givers ...... 5  Patient@home Facts ...... 6  Monitoring ...... 8 Cases: Hospital Home ...... 10 Innovative Technology Used for Treatment of Wounds ...... 12 Spiromagic ...... 13  Care in Own Home ...... 14 Cases: Exoskeleton for the Arm and Shoulder Region ...... 16 Detection and Identification of Body Fluid ...... 18 Operating System for People with Reduced Cognitive Functions . . 19  Rehabilitative training ...... 20 Cases: Development of ReHApp ...... 22 Rehabilitation with Industrial Robots - Universal RoboTrainer . . . 24 Game Technology for Rehabilitation ...... 26  Patient@home Makes a Midway Evaluation ...... 28  Information and Knowledge Management ...... 32 Cases: Acquire-ICD ...... 34 Identification of High-Risk Patients ...... 36 DiabeticLink Denmark ...... 37  Information and Communication Technologies (ICT) ...... 38 Cases: Adaptive Software Platform for Telemedicine ...... 40  Fast-Track ...... 42 Cases: Google Glass-testing at OUH ...... 44  Project Partners ...... 46  Project Overview ...... 47

patient@home 3 FOREWORD

Denmark is facing major challenges within the healthcare sector, including a growing need for new thinking and innovation that can provide better prevention, rehabilitation, more outpatient treatments instead of hospitalizations, and effective patient care – possibly in own homes .

One of the barriers to effective innovation and In the latter half of the project all this will be implementation of novel medical technology translated into more concrete trials and imple- solutions is to get solid data on the effectiveness mentation of new technologies and services for of the critical interaction between users, thera- the benefit of all parties including citizens, the pists, manufacturers and inventors. healthcare sector and industry.

Innovation Fund Denmark is a co-investor in The examples are advanced healthcare technol- the Patient@home project, which is an exam- ogy solutions that support the empowerment of ple of cooperation between public and private cardiac and diabetes patients through co-respon- companies that by means of test facilities and sibility and self-care, and technologies that can quantitative knowledge sharing can build bridges help acutely ill, geriatric patients to remain in between all the players. their own homes. They are expected to contribute to the introduction of specific improvements Within the first half of the duration of the pro- within the healthcare system in the foreseeable ject, the framework for quantitative and uni- future. form testing of promising new technologies was created. A number of interesting sub-projects I hope you enjoy the publication. have been initiated, which can potentially reduce the hospitals’ resource consumption and increase Director Peter Høngaard Andersen, patients’ active involvement in their own health. Innovation Fund Denmark

4 patient@home GRANT GIVERS

Patient@home Grants

The Patient@home project is sup- In addition, Southern Growth Forum, ported financially by the Danish a platform for regional develop- Council for Strategic Research and ment activities, supports Patient@ the Danish Council for Technology home with DKK 18 .6 million . South- and Innovation (both councils are ern Growth Forum brings together now part of Innovation Fund Den- municipalities, companies, organ- mark) under the auspices of the isations and research institutions Danish Ministry of Education and in order to identify and improve the Science . conditions for innovation and business development in the Region of The Councils’ support amounts to Southern Denmark . Southern Growth DKK 70 million and the duration Forum’s three main tasks include of the project is five years starting preparation of a business develop- March 2012 . ment strategy and action plan, monitoring of regional and local growth Patient@home is a so-called SPIR conditions and recommending co-fi- initiative . The SPIR programme sup- nancial support to regional business ports initiatives that strengthen the activities . link between strategic research and innovation . Focus is on more effi- Together with the project partners’ cient knowledge sharing and fast- in-kind contributions, the total er and more interactive use of new budget of Patient@home amounts to Photo: Samuel Brøgger, Danish Technological Institute knowledge and innovation in the pri- DKK 190 million . vate and public sectors .

patient@home 5 PATIENT@HOME

– At the intersection of research and innovation

Patient@home is the largest Nordic telligent healthcare technologies and ser- responsibility for their own health and healthcare research and technology in- vices. treatment. In addition, the projects add novation project focusing on developing enhanced quality to the healthcare sector new technologies and services for espe- Cooperation ensure relevance through technology-assisted treatment, cially rehabilitation, care and monitor- and impact monitoring and rehabilitation in pa- ing within the Danish healthcare sector. The platform includes more than 60 na- tients’ own homes – before, during and The Patient@home platform includes tional and international partners from after admissions. more than 60 national and internation- the public and private sectors. al partners from both public and private sectors. The project’s strong focus on close co-op- Target areas eration among health professionals, pa- New ways of thinking: Improvement of Through an interdisciplinary and open tients, private companies and research the healthcare sector through technol- public-private research and innovation institutions will ensure relevance and ogy-assisted treatment, monitoring and cooperation among healthcare profes- impact of the developed products and rehabilitation patients ‘own homes – be- sionals, patients, private companies and services. This kind of cooperation is a fore, during and after admissions research institutions Patient@home will guarantee that all products and servic- develop a number of new healthcare es are designed in compliance with user Innovation: Targeted development of technology products and services that needs and acceptance, and that all results new technologies and services together may actively reduce both the number are based on the latest research findings with companies, healthcare profession- and duration of hospital admissions in as well as the companies’ and especially als, end users and research institutions Denmark. the hospitals’ development and business plans. Empowerment: User-driven development Aim of technologies that helps patients to take The aim is to develop 40 new products The project’s business partners will get responsibility for their own well-being and services that can support the health- a unique opportunity to move one step and treatments – and allows them to be care sector’s increasing need for better closer to the latest knowledge on health- patient in own home and faster rehabilitation, more outpa- care technology mainly rehabilitation, tient treatments and in-home care and care and monitoring of patients in their Knowledge exchange: Transfer of new re- admissions. The development of such own homes. The project’s hospital part- search and knowledge to Danish compa- technologies should minimise the pres- ners will be able to follow the develop- nies – for the benefit of development and sure on hospitals’ financial and human ment and maturation of tomorrow’s maturation of new healthcare technolo- resources as well as increase patients’ ac- healthcare technologies and services, gies and market areas tive participation and motivation for tak- and the project’s local partners will get ing responsibility for their own health. a unique opportunity to take part and Research: Creating new research and make an impact on the development of knowledge on development and use of In addition, these technologies will ensure a wide range of cutting-edge technologies healthcare and related technologies – that healthcare professionals through- that are based on the in-home rehabilita- based on interdisciplinary collaboration out the sector may have both valid and tion needs of citizens and patients. with end-users, research institutions, consistent data for the assessment of the companies and healthcare professionals individual patient’s need for treatment. Five major action areas and six Besides, Patient@home will provide Dan- thematic project categories ish companies with access to the latest Patient@home combines targeted re- knowledge, laboratories and real-life test search and innovation in a variety of facilities, i.e. an optimal starting point healthcare technology projects, all of for building strong international market which focus on user-driven development positions in terms of innovative and in- of technologies that help patients to take

6 patient@home Project categories: FACTS Since the start of Patient@home in 2012 more than  Monitoring: Remote follow-up of the patient’s condition 60 active research and development projects has been launched . 13 products and services are now  Care at home: completed and 41 companies have participated in the Technology that supports patient care and stay development activities – and new businesses keep in own home coming and showing interest in the project .  Rehabilitative training: Physical training using modern technology In the second half of the life of the Patient@home project extra attention will be paid to innovation  Knowledge and information projects . As the research activities come to an end, management: focus will be directed towards use and activation of Data capture, data analysis and data research results in various projects . visualisation Information and communication How companies use and activate the new know  ledge and research that have been developed in the technologies: project’s first period will continue to be a major area Development and Design of Smart-Home technology that can support admissions in own home of attention . Active involvement by both companies and end users of the new products and solutions will,  Fast Track: therefore, remain an important subject . Fast and flexible testing or implementation of new technology

patient@home 7 MONITORING

Ensuring proper care for citizens and patients while they are staying at home is associated with technology sending information continuously between citizens and caregivers . We call it monitoring .

8 patient@home By Peder Jest sugar levels and send part of the data Medical Director, back to the doctor or hospital. At hos- Odense University Hospital pitals, patients accept being monitored Member of the Executive Board of or kept under surveillance, for example Patient@home in terms of continuous registration of their heart function. The same is the case for modern types of pacemakers that remotely control patients’ heart rhythm disorders. Many care centres and hospitals have introduced modern cameras that can alert caregivers and enable them to prevent elderly and disabled from fall- ing and potential harm from falls. Maybe A growing number of older adults ipalities and hospitals. Thus, the interest the future and the use of new technology suffer from chronic conditions and in new solutions reflects an area with will bring even more solutions, such as the number of health professionals many facets. chip implants that can control and regu- is declining . If patient treatment and late functionalities remotely. Ensuring proper care for citizens and quality of life are to form a synthesis patients while they are staying at home Every time we work with projects and in the future, it is necessary to is associated with technology sending in- new technologies, we should have a dis- introduce self-monitoring and remote formation continuously between citizens cussion about the impact of the technol- monitoring concepts . Hence, the use and caregivers. We call it monitoring. ogy. Patients must take independent de- of monitoring technologies are cisions on their specific treatment expected to increase steeply, i e. . options but also decide whether they will let others influence their lives. surgically implanted equipment It’s about empowerment, which is transmitting messages on Ensuring proper care for the ability to gain control over and required adjustments and citizens and patients while take responsibility for one’s own life replacements, functionality and they are staying at home is and situation. new high-tech measuring tools associated with technology Data ownership is another chal- for mobile devices . sending information lenge associated with monitoring continuously between citizens as it can be challenging to deter- This scenario does not only reflect and caregivers . Some might mine who owns the data. As a re- enthusiasm for technology but new sult of monitoring, a large amount treatment methods with the aim of perceive such monitoring as of data is gathered e.g. blood pres- ensuring that the patient can live surveillance as it can be intense sure checks and it is important to as independently and self-reliantly and frequent . This is an ethical avoid that caregivers and citizens as possible. This requires not only dilemma which we as members are overwhelmed. It is important to technological developments and ask certain questions such as: What technological opportunities but also of society and as individual kind of data agreement should be ethical considerations and commit- citizens must relate to . signed between the therapist and ments to cultural changes as we the citizen? Who is responsible for move into the foreseeable future. the data? How much data should be collected? And when and how should we Patient@home focuses on new types of Some might perceive such monitoring as act on this data? health technology. The overall goal of all surveillance as it can be intense and fre- research projects is to develop new solu- quent. This is an ethical dilemma which These issues are discussed and handled tions and practices for the benefit of the we as members of society and as individ- in the project category “Monitoring” in individual citizen, to enable the patient ual citizens must relate to. Already today, Patient@home. It is important that we to stay at home in periods of illness or many patients with chronic conditions perform research in this field to create a when handling a chronic condition. Such are monitored and many do it themselves common framework for rules and rights, solutions will not only benefit the indi- and the results are reported back to the but also to ensure some level of freedom vidual patient, but also the underlying caregivers. As an example, people with in the introduction of new medical tech- systems like healthcare services in munic- diabetes regularly control their blood nology.

Monitoring 9 HOSPITAL HOME

The Patient@home project Hospital Home is testing technology that supports home hospitalisation of acutely ill, elderly medical patients, a group that accounts for a large proportion of the total admissions to Danish hospitals, and the number of patients is rising steadily . This situation creates challenges in relation to future hospitals where we will have significantly fewer beds, and there is thus a need to test alternatives to traditional hospitalisation routines . Moreover, weakened, older people are often more vulnerable to hospital-acquired infections and confusion, which in turn increases the risk of falls and disability during and after hospitalisation .

The solution that project Hospital Home determining diagnosis, treatment and laptop for communication and data col- offers is based on close cooperation be- hospitalisation. If treatment can be per- lection. When the patient is discharged, tween the treating team from the Geri- formed at home, interested patients can the equipment is removed again and the atric department at OUH, specially be hospitalised at home. In such cases, patient referred to home-care service. trained employees working in Odense the patient is accompanied to his/her Municipal’s home service, and a number home assisted by a project nurse from The project is a feasibility study – in of researchers, who investigate the use of the Geriatric Department of OUH and a which the main question is: Is it at all telemedicine and sensor and monitoring medical student, who will stay in the pa- possible? An important element in the technology. In addition, the development tient’s home for the first 8 hours. project’s DNA is to develop along the and testing of the technological set-up way and to try and find alternative solu- is carried out in collaboration with the A digital lock with an ID-card key at- tions, in case something is not working. enterprises Systematic ANYgroup and tached to it is installed in the patient’s And there are challenges. First of all, it Lindpro and the healthcare sector. home, so that all employees who enter the has proved difficult to find suitable -pa home will be registered. In addition, the tients; many are too ill and unstable to When an ill, elderly patient is admitted following technologies will be installed: stay in own home. Another challenge is to hospital, the first day will be spent on emergency call, webcams, fall sensors, the technological solutions. If the sensors

10 patient@home are too “sensitive” it will send too many in project Hospital Home and to be hos- presented by the following companies: false alarms, which is another burden on pitalised at home instead of at the hos- NETomsorg, Yesgroup, Access Technol- busy health professionals. But if the sen- pital, and this situation is difficult to ogy ApS, which have now been merged sors are not sensitive enough, there is a change. Perhaps home-hospitalisation is into ANYgroup, and Systematic and risk that there will not be responded to a offered too late in the process? With a Lindpro. dangerous situation in due time. It takes better opportunity for detection and di- several attempts to strike the right bal- agnosis of ill, elderly citizens in primary Henrik Klode, CEO of ANYgroup, has ance. Finally, the effort demands a new care, Hospital Home could conceivably benefitted greatly from participating in form of cross-sector organisation whose be established even earlier in the disease Hospital Home: success depends on shared understand- process – and in-hospitalisation may be - Hospital Home has been a kick-starter ing and knowledge about the treatment avoided completely in some cases. and has contributed greatly to our suc- of the acutely ill, elderly patient and the cess and growth as we have been able to use of new technology. It’s hard to ob- Conny Heidtmann, Innovation Network use the project as a reference. Now, we tain routine when there are so few pa- RoboCluster, have more than 10 municipalities and 3 tients and that creates uncertainty about who is an Innovation Manager, says that hospitals as customers, and in 2015 we the task both at the hospital and within many companies have shown great in- have included a number of Norwegian the municipality. Through continuous terest in Hospital Home right from the distributors, and we expect to introduce sparring between the project team from beginning of the project that is one of the more distributors soon. We have part- Odense University Hospital, Odense Mu- flagships of Patient@home: nered with Lindpro in terms of instal- nicipality and the companies behind the - At one point of time we had 11 inter- lation tasks and as a distributor of our technological solutions, everybody tries ested companies, all with appropriate products in Denmark. to optimise the technique. technological solutions for Hospital Home; the companies were divided into The project is also supported by the Project Manager and Consultant Jens-Ul- two groups that both presented a variety Velux Foundation . rik Rosholm, the Geriatric Department of of solutions, and a selection committee Odense University Hospital, says: from Odense University Hospital and - Most patients are too ill to participate Odense Municipality chose solutions

• Fall sensor • Emergency call

• Alarms are received on smartphone Patient in • Check-up through webcam OUH Geriatric own home • Daily rounds in the home by Department a doctor and nurse

• Support and care as needed • Close dialogue about the • Provision of prescribed care and treatment by treatment, e.g. penicillin means of shared web-based through a drop documentation platform and telephone contact

Odense Municipal Geriatric Care

Monitoring 11 INNOVATIVE TECHNOLOGY USED FOR TREATMENT OF WOUNDS Testing of 3D camera in clinical practice

Diabetic foot ulcers constitute a grow- assess the wound characteristics. A pilot part of the project, we follow a group of ing health problem in Denmark concur- study has examined the wound charac- newly referred patients with diabetic foot rently with an ageing population and an teristics in 36 wounds in 30 patients ulcers at the University Centre for Wound increase in diabetes prevalence. Diabetic using the 3D camera. The study found Healing at OUH. The patients are moni- foot ulcers are among the most serious better correlation to clinical assessment tored for 1 year or until complete wound and costly complications of diabetes. It compared to the 2D images (iPhone 4s) healing, amputation or death. At base- is estimated that 85% of non-traumat- used in telemedicine. line, patient data is collected and wound ic lower-limb amputations are preceded examinations are performed including by diabetic foot ulcers. Several studies Purpose measuring the wound size using the 3D have found that the wound size, includ- The aim of the project is to evaluate the camera. This is repeated at regular inter- ing depth, is one of the major etiologic accuracy and variability of the wound vals. Patient and wound characteristics factors for delayed wound healing. Previ- measurements using the 3D images. A are correlated to the wound healing, and ously, the 2D measurement methods have large cohort study investigates whether we try to illuminate the clinical variables been used to assess wound healing. wound measurements by the 3D images that are associated with wound healing can be used for monitoring the wound in diabetic foot ulcers. We have recently published a review in healing process in diabetic foot ulcers. which we have described various 3D Perspective measurement techniques, which have Method Line Bisgaard Jørgensen tells that they made it possible to evaluate the process Physician and PhD student at the Depart- will test the 3D camera in their daily of wound healing in relation to all di- ment of Endocrinology, OUH, Line Bis- work at the clinic, which should give mensions including depth. None of 3D gaard Jørgensen, tells: them an opportunity of commenting measurement methods have been widely - In the first part of the project we con- on clinically relevant variables with im- used due to low accuracy, high cost level duct a validation of the wound measure- pact on the wound healing. Their setup and complexity to use for the clinicians. ments using the 3D camera. Forty-eight provides a validation of the equipment, patients with various types of wounds which has not been sufficiently described In our project, we use a newly developed are measured by four clinicians using the earlier. 3D camera that can measure the wound 3D camera, and compared with standard perimeter, area and volume, as well as measurement methods. In the second - We expect that the 3D camera can be used in clinical trials to investigate the effect on wound healing by various wound- care regimens. This is an area with weak evidence. The 3D camera is not yet commercially available, but the future vision is that the handheld 3D camera can be used in a telemedicine approach by wound-care nurses treating patients in their own homes and at the hospital for treating chronic wounds including diabetic foot ulcers.

The project is a collaboration initiative between the Department of Endocrinology at Odense University Hospital and the company Teccluster A/S .

12 patient@home SPIROMAGIC Electronic spirometer can monitor COPD patients and register their condition

The electronic lung function measuring Spiromagic is an electron- device, Spiromagic, ensures better treat- ic lung function measuring ment and prevents attacks and hospital- device that encourages and isations of people suffering from COPD. promotes patient involvement The spirometer records changes in con- and improve home monitor- ditions over time so that action can be ing so that the patient and the taken early on in case of changes/deterio- therapist get a more effective ration in the patient’s condition. information basis for tailoring By detecting changes in lung function at the treatment. an earlier stage, it is possible to prevent attacks and deterioration. Linking cause User involvement in parameters with measurements leads to focus an increased knowledge of own lungs Spiromagic is created in close and thus an opportunity to avoid or limit cooperation with users and the causes that could lead to deteriora- the healthcare sector (patients, tion or attacks. Besides, “bogus” causes, doctors, nurses and physio- which might have been believed to be therapists) and the Danish Lung Asso- novation Ltd., who is in charge of Spiro- involved, will also, to some extent, be ciation has been involved in the entire magic, says: identified and thus allow the user greater development process. activity and fewer visits to the doctor’s. - Spiromagic is an affordable telemed- Under the umbrella of Patient@home, icine spirometer achieved and serviced Home monitoring of lung function Health Innovation Centre of Southern by the citizen himself. Data from the In Denmark, the latest estimates show Denmark has participated in the process, spirometer is transmitted wirelessly to a that about 436,000 people may have carrying out courses with user participa- smartphone, for example, and can then COPD (Chronic Obstructive Pulmonary tion and gathering feedback on spirom- be shared with the therapist. Spiromagic Disease), spread over approximately eter, user interface, instruction and the will create greater security and indepen- 166,000 with mild COPD (at this stage matching app. Furthermore, both Næst- dence, a better quality of life and prevent they might not have symptoms yet, but ved Healthcare Centre and the Danish emergency admissions. The spirometer will often get some if they continue to Lung Association have helped to recruit is not really a diagnostic tool, but rather smoke), approximately 230,000 have people with COPD as participants in the a sophisticated tool to be used to detect moderate COPD, and about 40,000 have Patient@home activities, providing valu- changes in conditions over time, so that severe and very severe COPD and will able feedback on Spiromagic. action can be taken if there is a change/ often have daily symptoms such as short- Conny Heidtmann, Innovation Net- deterioration in the citizen’s condition. ness of breath. 23,000 hospitalisations work RoboCluster, who is Innovation per year are due to COPD. Manager in Patient@home, says that the Spiromagic is now CE marked and will company behind Spiromagic has a great be upgraded with a clinical CE Mark as In the health strategy “The sooner – the understanding of the need for user-driven “Class I with a monitoring function”. better”, the Danish government has list- innovation. Furthermore, the company ed two ambitious goals towards 2025: has throughout the process been very The project is carried out in cooperation (1) The number of acute admissions per quick to implement the changes that with various players from the partner COPD patient must be reduced by 20%; have been proposed by the citizens and group of Patient@home, including Inno- (2) The reduction in admissions is ex- the end-users that have used Spiromagic. vation Network RoboCluster, the Danish pected to be managed by using telemed- Lung Association, Health Innovation Cen- icine solutions that detect early signs of The final product tre of Southern Denmark, Næstved Munic- the disease and thus can react before hos- Business Development Director Jørgen ipality’s healthcare centre and the compa- pitalisation is needed. Ole Kjær from the company Move In- ny Move Innovation ApS .

Monitoring 13 TECHNOLOGY-ASSISTED CARE IN OWN HOME

Patient@home covers several research and innovation activities aimed at developing technologies and robots that in various ways can support and assist outpatients with their activities of daily living (ADL)

Photo: Fraunhofer, IPA, Jens Kilian

14 patient@home By Jørgen Løkkegaard Centre Manager, Centre for Welfare and Interaction Technology, Danish Technological Institute (DTI), Innovation Manager in Patient@home and a member of its Board of Directors

The overall objective of Patient@home is ing and increasing complexity. The goal portfolio. The estimated number of Dan- to develop technologies and services that is to make the robot understand spoken ish companies that produce healthcare will enable patients to be treated in their commands, to interact, to find its way technology products is 1,400-1,500. own homes. The development of such around a home and to perform simple solutions, will enable people, who have service tasks such as retrieving a glass of The aim of continuously demonstrating previously been hospitalised for short- water and help a person out of bed. the latest research and innovation results er or longer periods of time, to stay in achieved by Patient@home e.g. at the their own homes despite temporary or The market potential of healthcare tech- premises of DTI’s CareLab in Odense, long-term disabilities caused by surgery nology products that are developed and is to make Danish companies as well as or chronic diseases e.g. COPD, dia- hospitals, municipalities and pa- betes and dementia. tients aware of the possibilities of future healthcare technologies and Patient@home covers several re- robotic assistants. In this way, cus- search and innovation activities The expectation is that tomers and businesses will get a aimed at developing technologies Patient@home, directly and unique opportunity to witness and and robots that in various ways can indirectly, will contribute experience how it may be possible support and assist outpatients with to innovation and product to create new products or services their activities of daily living (ADL), on the basis of the platform’s re- thus making patients less depen- development of future sults. dent on care and practical help – in solutions that can help patients short, the goal is to make future pa- remain self-reliant in their own The expectation is that Patient@ tients more resourceful by means of homes despite illness and loss home, directly and indirectly, will new technology. contribute to innovation and prod- of functional capacity . uct development of future solutions An example of the platform’s re- that can help patients remain self-research and innovation activities liant in their own homes despite ill- within this field is the German-made ness and loss of functional capacity. service robot, Care-O-Bot, which is de- manufactured by Danish companies is Patient@home will thus be instrumental veloped by the Fraunhofer Institute for large and soaring, and may pave the way in bringing technology-assisted care into Manufacturing Engineering and Auto- for a more intelligent healthcare sector a Danish nursing home in the foreseeable mation. The robot is being further de- – nationally as well as internationally. future and help older people with physi- veloped under the umbrella of Patient@ The importance of the Danish healthcare cally demanding activities of daily living home and tested by DTI and University technology trade is well documented, so that they can enjoy an independent of Southern Denmark, and will gradually and it constitutes a significant part of and resourceful life in their own homes. be involved in more activities of daily liv- Denmark’s employment rate and export

Photo: Fraunhofer, IPA, Jens Kilian

Care in own home 15 EXOSKELETON FOR THE ARM AND SHOULDER REGION

Patient@home project on development of new and customised exoskeletons for patients with paralysed or reduced arm function

Arm paralysis is a frequent and Skilled orthotics professionals are some- growing disorder. It typically oc- times able to customise orthoses capable curs due to traffic accidents, falls of restoring a degree of the user’s elbow and sports activities – such as function with elastic mechanical elements mountain biking – when athletes such as rubber bands or springs. cause damage to nerve fibres placed between neck and arms. Purpose and vision Therefore, young and active New and personalized technology can adults constitute the great ma- help people with paralysis that need ei- jority of the patient popula- ther rehabilitation or support in their tion, who might be left with a everyday lives – both during and after serious and lifelong disability hospitalisation. and sharply reduced ability to work. Similar paralysis Through the project “Exoskeleton for or disability of the arm and arm and shoulder region” Patient@home shoulder region also occurs has focused on exploration, develop- as a result of strokes, some ment and design of a compact and light- neurological disorders and weight exoskeleton that can support and general aging; and affect balance the movements of the arm and thousands of people with shoulder region of the above-mentioned considerable personal and patient group. The project uses a num- social consequences. ber of advanced computer models of the human body, which enable the design of The inhibitory paralysis individual and personalised exoskeletons and disabilities – both for users who typically are disabled to the partial and complete – extent that they cannot bring the hand up may mean that those to their mouth. In this way the project affected need help extends the possibilities of the orthoses from others to cope from elbow to shoulder. with the most basic daily activities such The project aims to design and develop a as eating, drink- prototype that is lightweight, inexpensive ing, combing hair and comes with a relatively simple design and doing other that restores the ability to perform every- personal hygiene day tasks in patients with a very small tasks. residual strength in their arms.

16 patient@home Ph.D.-student Miguel Nobre Castro, Department of Mechanical and Manufacturing Engineering, Aalborg University

Project status Solving the task requires research in di- verse areas from computer models of the human body to the creation of complex geometries. The results are tested regularly by implementing them in prototypes. Currently, the second prototype is being produced and its most important characteristics are that it has been 3D-printed to match the user’s body shape, and that the mechanical springs have been replaced by soft rubber elastic bands. Attempts have also been made to design a prototype that can reach as many points as possible in a large working area in front of the body.

- We are constantly working in an intersection between creating something that is simple to produce and use and yet provides a great improvement for the user, says Project Manager and Professor John PATIENS@HOME ILLUSTRATED Rasmussen from Aalborg University.

- New technologies like 3D printing Anni – relative of Poul (74 years): and body scanning with Kinect cameras (known from Microsoft’s Xbox gaming My husband was treated for an very sceptical, I guess, but during console) will have a major impact on aggressive prostate cancer last the trial both Poul and I have re- customised solutions in many areas in autumn . One of the consequences alised that the new technology the near future and this Patient@home of the illness was that he had a de- and the delicate sensors make a project has many exciting prospects, con- bilitating complication in the form difference . If a urination accident cludes John Rasmussen. of a spinal-cord injury that caused happens during the night, the sen- paralysis in his legs and loss of sors will alarm the caregivers . The The project is conducted in close collab- sensation . Today, he is doing well intelligent sheets can also detect oration with Aalborg University, Depart- considering the circumstances, other instances of fluid losses . Ob- ment of Mechanical and Manufacturing but he is partially bedridden (re- viously, all this has not been easy Engineering, the Orthopaedic Research quiring transfers in bed) and he for neither Poul nor me and the Unit of Aalborg University Hospital and has at times difficulty urinating . children, but because Poul gets the the Prosthetic Centre of Risskov. Recent- Via the hospital we were invited to care he needs – and the technology ly, a new collaboration was established participate in a trial where his bed helps us – then he can be staying overseas with Nemours/Alfred I. DuPont has been equipped with very mod- in our home . And that means ev- – Hospital for Children in Wilmington, ern sheets that can detect leaking erything . Delaware: not only one of the best chil- body fluid . In the beginning I was dren’s hospitals in the United States, but also the creators of the Wilmington Ro- botic Exoskeleton (WREX).

Care in own home 17 DETECTION AND IDENTIFICATION OF BODY FLUID Development, testing and evaluation of existing technology for detection of fluid loss in relation to new patient groups

Sensors for use within the field of care and can be monitored and cared for in their fluids has great potential, and here at disease prevention have great potential, own homes, if detection and identification CVI, we have a great interest in partici- and many sensor-based solutions are al- of leaking body fluids is added to their pating in this sensor development work. ready everyday technology for many peo- regimen. In addition, early detection and The next step includes building a proto- ple. Examples include measuring blood subsequent alarm of fluid loss will make it type, where, in addition to the technical pressure, heart rate, oxygen saturation, possible to be patient in own home. Gen- specifications, we also focus on price and and blood sugar. They are all measure- erally, creating security and a good night’s quality. It is important that Astrid Leisner ments, which simply and effectively can sleep for patients in own homes, is high & Son now has a framework for cooper- be carried out at home today. A pacemak- on the agenda. ation with a potential producer that may er is also a good example of a well-devel- also be part of the development work. oped sensor technology that constantly The project, which started in 2013 in col- monitors the heart rhythm. As soon as the laboration with Danish Technological In- sensor detects absence of heartbeat, the stitute and Health Innovation Centre of pacemaker stimulates the heart. Southern Denmark, is expected to lead to the development, testing and adapta- Sensors detect various physical impacts tion of technology aimed at specific tar- like pressure, stretch, temperature, hu- get groups and to involve patient groups midity, magnetism, light, sound etc. directly in the development and testing These are all parameters that can be de- pathways, so that the final product can tected with the correct sensor type. As be adapted to specific patient needs. soon as a measuring or monitoring need Researchers involved in Patient@ is identified, it will usually be possible to Director of Astrid Leisner & Son, Sune Erik develop a system based on commercially Leisner, says: home activities are presented available sensors. However, there are still - Work on the project “Detection and with a unique opportunity to solve needs that require a more basic develop- identification of body fluids” runs -ac specific and relevant issues for the ment of the sensor itself, and not just of cording to plans. A needs analysis has clinical environments in hospitals the measurement system. been made, which also includes the and municipalities – in close coop- technology benefits of the citizen, and eration with companies, innova- Within the field of care – both at home we partnered with a company outside and in hospitals – there is a need for de- of Denmark and have started trials that tion hubs, researchers and health tecting bodily fluid in the bed. It will cre- test solutions using a technology that is professionals . This composition is ate greater security for the citizen/patient different from the one that Astrid Leis- important to promote a cross-dis- and allow for better care, because action ner & Son has and markets today. The ciplinary collaboration between can be taken earlier if necessary. Types of experiments are promising, and we have professionals and researchers . It bodily fluid include vomit, urine, sweat, decided to continue to work together, also opens up new opportunities blood, and exuding wounds. and we are now about to start producing prototypes which use their application. for user involvement, testing of Objectives and results In addition, we are working to optimise results and taking developments The Patient@home project “Detection and both price and quality. from the prototype level to becom- identification of body fluids” is, therefore, ing useful products – all in close examining how to further develop tech- Consultant at Centre for Welfare and cooperation with enterprises . nologies from the company Astrid Leisner Interaction Technology at Danish Techno- & Son and make them more responsive to logical Institute, Lars Vincent Jørgensen, #Uffe Kock Wiil (Professor at The out-patients’ needs. The project examines says about the project cooperation: Maersk Mc-Kinney Moller Institute, whether there are new patient groups that - Detection and identification of body University of Southern Denmark, Project and Research Manager in Patient@ home and a Board Member) 18 patient@home relatives or caregivers. The intention is to stimulate their existing cognitive functioning. The vision is to increase dignity and life quality of citizens with impaired cognitive functions.

The project is expected to lead to the following specific results:

• A survey of which citizens with impaired cognitive functions are in need of a simplified operating system (besides citizens with dementia) • Further development, testing and adjustment of the operating system to suit the needs of the citizens • Integration of external input by way of, say, sensor inputs • One or more new commercialised products from Tele Call

Director of the company Tele Call, Henrik OPERATING SYSTEM Bryld, says: - In our business, we focus on technology that provides safety and better quality FOR PEOPLE WITH of life for the elder and disabled citizens. To ensure the continued development of communication aids we participate reg- REDUCED COGNITIVE ularly in projects that focus on how the latest technology can help create a better everyday life for the individual citizen. FUNCTIONS Our participation in the Patient@home platform has meant that we have found Development of an operating The system contains a few simple func- new ways of collaboration across disci- system for smart phones/ tions, for example a calendar with images plines. Technology and innovation are which helps citizens to remember agree- key concepts in Patient@home and core tablets that guides people with ments, various guides on how to perform competencies at Tele Call. impaired cognitive functions everyday activities such as making coffee through everyday activities or doing laundry, and a life-history func- Centre for Welfare and Interaction Tech- tion that by means of pictures can relay nology at Danish Technological Institute Simple everyday tasks can be challenging different episodes in the citizen’s life. is project collaboration partner in the pro- to remember for people with impaired ject . Consultant Lars Vincent Jørgensen cognitive functions. Therefore, they need Vision and purpose explains: the help of relatives and or caregivers. In the project “Operating system for peo- - The project has got so far now that The company Tele Call has developed a ple with reduced cognitive functions”, Tele Call has a product that is ready smartphone named DoMyDay. It has a Patient@home continues to optimise the for market introduction and real-world very simplified operating system and it results and experiences from the project testing at the premises of several good, is targeted at people with mild dementia. “Dementia in the home”. local contacts. The product appears well The system supports and relieves some of thought out, and most importantly, very the challenges that people with impaired The project’s goal is to improve the life user-friendly. And there are many possi- cognitive functions encounter in their of citizens with impaired cognitive func- bilities of further development, not least everyday life, thus making them able to tions so that they perform everyday ac- in view of the upcoming market intro- better take care of themselves. tivities without depending on help from duction and future results.

Care in own home 19 Patient@home develops Innovative Technologies that help patients do workouts and rehabilitation exercises at home – and check the results!

REHABILITATIVE TRAINING

20 patient@home By Per Kjær monitoring how the patient performs and Associate Professor, Centre for Muscle how pain, if any, appears and disappears. and Joint Health, Department of Sports, Adjusting exercises regularly can serve Science and Clinical Biomechanics, several purposes: When doing fitness and University of Southern Denmark weight training, the intensity must be in- Work Package Leader for Rehabilitative creased to improve performance. The Training in Patient@home same goes for rehabilitative training, but additional factors play a role here. Exer- cises may have been designed to reduce start at the right physical level and use the pain, but doing exercises against increas- training programme best suited to the pa- ing pain is probably not appropriate, be- tient’s condition and age. cause pain changes the way muscles are A good example of this is the many apps functioning. Therefore, we have tried to The Danish health sector is facing major for fitness training and running, as they develop apps that provide users with in- challenges with an increase in age-related register a starting point and prepare a structions on how to change strategy and disorders, and lifestyle diseases as well as programme that takes into account the exercise intensity when the pain increases. highly specialised and expensive exam- patient’s starting level and age. Similarly, The greatest challenge for all kinds of inations and treatments. In the years to a physiotherapist will assess the forces in training is motivation. How does one stay come, resource priorities will be manda- arms or legs when planning training for motivated? Exercises are not just some- tory within the health care sector resulting a patient with paralysis of one side of the thing that should be done a single day or in hospital departments, doctors, physio- body following stroke. Similarly, a profes- two. It is a long and continuous process, therapists and chiropractors being much sional therapist will recommend pain re- if results are to be achieved on perfor- more engaged in diagnostic procedures lieving exercises that can help the patient mance, pain and functionality in everyday and evaluations rather than treatment in acute pain from a disk herniation. The activities. We have looked at several mo- – and citizens and patients will become two latter examples are time consuming, tivating factors. Fun and games play an much more responsible for their own re- and it is a challenge, for instance, to mea- important role in the project by means of habilitation and training. Self-manage- sure forces in arms and legs, movements interactive tiles with games (as described ment is the new trend. in the neck and how they change precisely in this publication), while use of apps with The first good news is that exercises and over time. information and instructions is another training are effective interventions for the strategy we have been considering. More health conditions that are the most costly When the starting point for training and information is available on the following for society: back and neck pain, osteo- rehabilitation has been identified, long pages (e.g. on RehApp). And it seems that arthritis of the knee and hip, other mus- and intensive training schemes are initi- the cause of motivation differs a lot from cle-joint disorders and activity limitations ated. So far the implementation of such person to person. following stroke. The other good news is schemes has been very resource-intensive, There are already many products on the that citizens and patients are increasingly but the emergence of new robotics and market that can support training and re- interested in taking responsibility for their sensor technology can be instrumental in habilitation. However, a common feature own health, asking “what can I do?” The helping such patients to train and do the of them all is the lack of the interactive third piece of good news is that the de- many exercise repetitions at home and aspect, or the interaction between the pa- velopment of technologies that can sup- without an expert standing nearby. tient’s training level, pain and response to port rehabilitation and training is rapidly In the Patient@home work package Re- training exercises. Likewise, there is no re- growing. habilitative Training we have investigated search available that documents sensors’ how to measure the rate of force develop- and robots’ precision capabilities in terms The challenges connected to prevention, ment during training and how to adjust of measuring movements and force, and rehabilitation and training activities are very precisely the level of resistance by no documentation on whether the effec- many, such as finding a patient’s starting means of robots. Robots can also guide tiveness of exercise and rehabilitation is point, composing a suitable exercise pro- movements of body parts which paralysed improving when technologies are inte- gramme, adjusting gradually the amount people cannot. This means therapist time grated. In the work package Rehabilita- of training needed and, finally, strengthen- saved. We have also looked at how we, tive Training companies, researchers and ing the patient’s own motivation. Wheth- by means of sensors, can measure move- patients work together with the aim of er the goal is to prevent overweight (and ments in a patient’s neck and lower back developing such innovative training and subsequent diabetes and cardiovascular as well as changes in the rate of force de- rehabilitation tools – as well as document- diseases) or to initiate rehabilitation af- velopment, thus obtaining the necessary ing their precision capabilities and eluci- ter a stroke, a broken hip or a herniated background for choosing the most ap- dating the potential treatment advantages disc in the neck, the patient must always propriate exercises for each patient while and economic benefits.

Rehabilitative training 21 DEVELOPMENT OF ‘REHAPP’

A technology-supported guidance and exercise application for patients with neck pain and radiation into the arm

Each year 8-10,000 more Danes suffer a future study testing the effectiveness Centre of Southern Denmark where they from arm pain arising from the neck. The of RehApp can take place. In this way, completed questionnaires on RehApp’s pain can be caused by an affected nerve the effect of the newly developed inter- relevance and user friendliness. For com- root from a herniated disc or osteoarthri- vention can be scientifically documented parison 11 control patients went through tis changes in the neck. About a fifth of in relation to the existing treatment for the usual procedures in the back centre. these patients are referred for surgery, pain, activity improvement and reduc- while the vast majority are offered pa- tion of health costs.” Project manager, physiotherapist Hanne tient education and therapeutic exercises. Rasmussen tells about the results: Project methods - 15 patients were involved in the test- In the acute phase, these patients often A prototype of an information and ex- ing of RehApp. The overall assessment experience severe symptoms and limita- ercise application was developed in col- of RehApp was positive, both in terms tions in their activities. Therefore, there laboration with researchers from The of user friendliness and relevance. All pa- is a need for close monitoring and super- Maersk Mc-Kinney Moller Institute, re- tients believed that RehApp was a useful vision to detect deterioration that may researchers from Institute of Sports Science remedy and that it gave them good guid- quire surgery, to prevent the development and Clinical Biomechanics at University ance and increased confidence in their of chronic pain and to help rapid relief of Southern Denmark, the IT-company situation. The patients expressed a need of pain. It is also vital that the patients ExorLive, and patients and clinicians for communication directly with a clini- experience control over their own situa- from The Spine Centre of Southern Den- cian through RehApp, improved audio tion and are able to maintain a normal mark. Principles from the innovation options, information about their neck life. The pain makes it often difficult for process were used, so that the process problem and choice of exercises. the patient to attend examinations and concentrated on identifying and gather- treatment. The use of information and ing knowledge about relevant technol- Expected results communication technology (ICT) may ogies, practices and user needs. On this Preliminary results from the pilot study therefore be beneficial for patients. background several versions of RehApp show that RehApp is a possible interven- were developed and tested. The process tion for patients with nerve root involve- Project manager, physiotherapist Hanne alternated between testing, interviews ment in their neck. After development Rasmussen says: and adjustments of RehApp. and adjustment of RehApp, based on the - The purpose of this Patient@home pro- results from the pilot study, a larger study ject is to develop RehApp, a technolo- The finished RehApp prototype was then testing the effectiveness of RehApp can gy-supported intervention. The develop- tested at The Spine Centre of Southern be carried out. If it shows positive results, ment takes place in an innovative process Denmark among 15 patients with evi- RehApp can be implemented and adapt- that maps out the scientific evidence for dence of nerve root involvement in the ed to rehabilitation programmes in pri- the efficacy of treatment, involves pa- neck. The participating patients com- mary care or in clinics for physiotherapy tients, healthcare professionals, engineers pleted questionnaires about pain man- and chiropractic care. and companies in order to investigate its agement and activities. They were given usability and relevance among patients information and instructions on how to Besides having potential benefits for the with nerve root complications in the use RehApp and they tested it at home patients, it might help the clinicians in neck. If the developed prototype of Re- for two weeks. The patients were then developing treatment approaches based hApp is found appropriate and useful, seen at a follow-up visit at The Spine on feedback from RehApp and the pa-

22 patient@home PATIENT@HOME ILLUSTRATED tients’ preferences and delivering a more tailored treatment approach. The results Jytte (72 years) from this project may therefore provide Last year, I fell in my home . I had home using screen training for my basis for developing more sophisticated horrid pain in my left hip and I exercise programme . Sometimes technologies that can improved the treat- could neither walk nor get up . Luck- we are a group of ‘patients’ that ment outcomes for not only patients with ily my daughter came by and had train together via a single video CR, but for other groups with musculo- me taken to the emergency room . call and a physiotherapist . Such skeletal problems. The following day I had a hip-frac- training sessions are motivating RehApp will also have potential of de- ture surgery . I was already up and in a different way, they make you creasing costs not only for the individual around 24 hours after surgery, and do your exercises and the physio- patient, but also in the health care system a week later I was discharged to- therapist guides and corrects you, and society because of decreased health gether with a training screen that if improvements are needed . It has care consultations and sick leave. should assist me during my daily helped me a lot and saved many rehabilitation training . I’m really trips to the rehabilitation centre in happy that I can train every day at town .

Patient@home acts as a collaborative platform for more than 60 partners across organisations and disciplines to develop new technology . Many of the findings appear within the umbrella of Patient@home, but the platform also inspires the partners to perform a number of research and development activities outside Patient@ home, just as a number of more permanent cooperation constellations have been established among the partners at this half-way point . Patient@ home thus provides a boost to the whole development of new healthcare technology . #Louise Skovborg Just (Head of Secretariat of Patient@home)

Rehabilitative training 23 Photo: Hanibal-Bach

REHABILITATION WITH INDUSTRIAL ROBOTS – UNIVERSAL ROBOTRAINER

Study of rehabilitation possibilities of injuries caused by stroke by means of industrial robots

24 patient@home Rehabilitation of disabilities linked to versity of exercises and tools we’ve seen strokes is a demanding task for the pa- used by the arm-rehabilitation team, and tient and a costly healthcare-sector chal- it is a direct consequence of the diversity lenge. of disabilities that patients have. Rehabilitation studies have shown that The need for individualisation is compre- many repetitions of exercises are an ef- hensive and it has led to the development Having reached the half-way point fective way of getting the brain to learn of a way by which the therapist and the of Patient@home’s lifetime, it is to control muscle groups with a view of patient, together with the robot, can re- improving the patient’s functional capac- cord the training path required. This is a great pleasure for me to note ity. done in two ways: The patient can hold that the project is on track . As we The project Universal RoboTrainer fo- the hand of the robot or he/she can be all live longer and more citizens cuses on the use of industrial robots for connected to the robot; the therapist sub- suffer from chronic diseases, new rehabilitation, because these robots are sequently helps the patient to perform innovative solutions are required designed to be flexible and to perform the exercise, while the robot records it to support people so that they can many repetitions. all. The exercise is then saved under the patient’s profile. The therapist can set stay longer in their own homes . Rehabilitation with industrial various parameters for the exercise, for This is the background for estab- robots example the speed and how much assis- lishing Patient@home, which, in With the support of the robots, patients tance the patient needs. an exemplary way, connects public can make specific movements that let An interface to the robot is being devel- knowledge institutions, treat- them regain functional capacity. Sen- oped which will help the therapists to ment centres, private companies, sors in the robots automatically help to create patient profiles, record and store determine the degree of support that the training exercises and set training param- staff and patients with the view patients need to be able to perform their eters, while the patients themselves will of developing and testing new exercises. be able to start/stop their exercises and healthcare technology solutions Focus is also on making it easy for ther- track their own progress and follow their that can work in real life for the apists to set up individual training pro- training history. benefit of patient involvement, the grammes and to make the training moti- The next step is to make the robot reli- quality of treatment and reha- vating for the patient. able and safe enough to perform pilot trials with patients. The first trials that bilitation programmes, resource Project objectives and results investigated the robot’s interaction with optimisation, and the growth of The project provides a good picture of ordinary, healthy people started in the Danish companies . It has been what is required to rehabilitate people autumn of 2015. exciting to follow the development with the assistance of industrial robots, of Patient@home, and we, the and it brings in new perspectives on how Conny Heidtmann, from the Innovation members of the Board of Patient@ to make the programming of the robot Network RoboCluster, Innovation Manag- easy for the therapists. This provides an er in Patient@home, emphasises: home, have enjoyed watching insight into how the interaction between - This project has a good and close inter- an extraordinarily focused and human and robot can be achieved, inter disciplinary collaboration with therapists result-oriented management team alia, by means of motion. from Odense University Hospital’s Neuro of Patient@ home and among the Rehabilitation Department at Hospital project participants . Associate Professor, PhD, Jacob Nielsen, Svendborg, which has been a decisive fac- The Maersk Mc-Kinney Moller Institute, tor for the project’s achievements so far. #Ole Skøtt (Dean, Faculty of Health University of Southern Denmark, says Sciences, University of Southern Den- about the project’s current status: Development Therapist Anne Friis Hansen mark, Chairman of Patient@home) - Right now we are working to emulate from Hospital Svendborg says: some simple exercises. Therapists define -The Neuro Rehabilitation Department the exercises, for example, through video at Hospital Svendborg has been a coop- sequences, illustrating each exercise from eration partner on the project since the The project is conducted in close several angles. This will then be the engi- autumn of 2014. It is an exciting project cooperation with Odense University neer’s template in relation to finding out with the development of the robot and Hospital’s Neuro Rehabilitation how the robot can best help the patient the associated interface. The robot is still Department at Hospital Svendborg, The to perform the same exercise. under development, but we are looking Maersk Mc-Kinney Moller Institute, The various exercises proposed by the forward to testing it in the Neuro Reha- University of Southern Denmark and therapists visualise rather well the di- bilitation Department. Innovation Network RoboCluster .

Rehabilitative training 25 GAME TECHNOLOGY FOR REHABILITATION

Development of method for impact evaluation of welfare technologies

New healthcare technologies created ties of using new healthcare technologies play and train on the tiles as they like – for health preventive and rehabilitative all the way through i.e. from the patient and the pilot tests show that older people training at hospitals will continue to en- is admitted to hospital and he/she is back very often like using the tiles. ter Danish homes and municipal training in own home. units. But, can technologies for rehabil- To simplify the implementation of the itation and prevention be moved from Besides an overall methodological under- tiles at institutional and domestic levels, hospitals’ controlled environments and standing of the extent to which training the project has developed, together with into the care sector and private homes? technologies have an impact both in and business partner Entertainment Robotics, outside the hospital, the project also ex- a new version of the modular tiles which And can reliable impact measurements amines the applied tiles’ ability to offer are lighter and thinner, and via connec- and useful training exercises using new customised exercises that suit the individ- tion to a tablet can document the user’s technologies be performed in uncon- ual citizen’s needs. activity on the tiles. Access to this ongo- trolled environments such as a citizen’s ing documentation of the use and users’ own home? These are just some of the Professor Henrik Hautop Lund from drive can for example be made from any questions that the development and in- Centre for Playware at Technical central office of therapists, doctors and troduction of new healthcare technology University of Denmark says: project managers via a server. The new brings about. A research project under - Impact tests on older people’s ability product will be produced by Entertain- the Patient@home umbrella looks into to function when using modular inter- ment Robotics, based in Odense. Enter- the problem. active tiles have shown that even short- tainment Robotics has already received term play on the tiles provides significant orders for the first 40 sets of the new ver- The vision improvement in balance ability among sion of the tiles, which are to be delivered Based on existing training technologies the elderly, and that in so doing they to Danish municipalities in late 2015. – modular, interactive tiles – the project also improve significantly their strength, examines the methodological options for stamina, mobility and agility. This is very With a broad US patent grant achieved, transferring healthcare technologies from important in terms of falls prevention. as well as international trademark pro- the hospital sector’s controlled environ- When playing on the tiles the elderly for- tection and CE, ROHS, ASTM and a va- ment and to local governments – and ul- get time and place, and hence also the riety of EN certifications, Entertainment timately also to the citizen’s own home. daily limitations in physical activity. Just Robotics wants to continue the develop- a short time of playing and training on ment and distribution of the tiles in Den- Through a series of specific exercises the modular, interactive tiles, lead to a mark, while opening export markets in performed on an intervention group and very large improvement in their balance 2016-17. then compared with those of a control ability. group without training, the project pro- Project partners: Centre for Playware at vides the basis for an overall methodical The first pilot tests in private homes have Technical University of Denmark, and study of whether training with techno- indicated that older people can perform Entertainment Robotics . logical tools provides the same effect the playful training on the tiles in their when performed at the hospital, at the own homes and prove very persistent in External partners: University of Siena, municipal level and in the citizen’s own the initial pilot tests. A set of 10 tiles is Trivulzio Hospital Milan, Gentofte Mu- home. The results will ultimately lead to placed in the bedroom, living room or nicipality, and the Health Department of a greater understanding of the possibili- hallway of the elderly, after which they Copenhagen University .

26 patient@home Patient@home sets the framework for how companies in cooperation with the users of their products in the health sector with the best possible basis for being able to sell their products . The companies get closer to the latest research and closer to the relevant resource persons who can positively contribute to that they can develop and sell their products below . As project manager of Patient @ home is exciting to see how all parties have the benefit of Patient @ home – and how the Patient @ home benefit Denmark . All players are united under a joint project with the sole purpose to bring innovative technology solutions to market . Patient @ home ensures that resources to developing innovative solutions used in the best possible and thus helping to meet the challenges that we are going to see in the future of health . # Søren Møller Parmar-Sielemann (Senior Consultant, Welfare Tech, a member of the management of Patient@home)

Rehabilitative training 27 PATIENT@HOME MAKES A MIDWAY EVALUATION

By Anders Lyck Fogh-Schultz by Danish hospitals because the number have comprehensive care and treatment Senior Consultant at Centre for Health of elderly people who develop chronic needs, and it puts pressure on the health- and Human Interaction Technologies, conditions like diabetes and heart/vascu- care sector as never before. Danish Technological Institute lar diseases will also grow. Lack of physical activity, poor diets and unhealthy Demographic challenges and The demographics and the lifestyles, such as smoking and alcohol technology-driven innovation general health situation in intake, have created a global increase in In 2015, Patient@home reached its half- chronic non-contagious diseases. Figures way point. The basic ideas behind the Denmark are changing . show that the majority of people over 65 project are about development of new We are living longer and longer and the suffer from two or more chronic condi- technological solutions that can reduce number of people above the age of 65 is tions. When we look at the 75-year-olds the pressure on hospitals’ financial and growing rapidly. Recent research shows and onwards, they typically suffer from personnel resources and support the that each year our life expectancy in- three or more chronic diseases. In fact, healthcare sector’s increasing need for creases by approx. 3 months. This chang- the number of individuals with two or better and faster rehabilitation as well as ing age structure together with the grow- more chronic conditions is greater than more outpatient treatments and hospital- ing number of elderly people and the the number of those with just one. And isations of patients in their own homes. resulting smaller workforce will be felt patients with chronic conditions often The new technologies will ensure that

28 patient@home healthcare professionals throughout the as an aid in a given treatment must be cardiac activity and ECG (Electrocardi- sector can get both valid and consistent familiar with it, and it must work. We ography) and send data directly to the data when required for assessing a pa- communicate daily by phone, tablet, In- caregiver’s mobile phone. In other words, tient’s need for treatment. In addition, ternet, and we take and send pictures via the technology makes knowledge and the new technologies, products and ser- smartphone almost constantly. We can data mobile for both sender and receiv- vices will help increase the patient’s ac- do the same in a treatment situation. We er – and mobility ensures that patients tive participation and motivation to take just need to take responsibility and par- carry their data with them everywhere, responsibility for own health. ticipate actively. However, I believe that explains Peder Jest. tomorrow’s citizens are and will be able Patient@home is, in other words, about to do it. And technology supports us al- Technology that works – also in patient health and technology-driven in- ready very much today. Let me give a few the future novation. examples: Diabetes checks are reported The prevalent idea of Patient@home is I met Peder Jest, medical director at via telemedicine solutions, patients with that technology – along with active pa- Odense University Hospital and a mem- certain types of foot ulcers can take pic- tient and public involvement – can help ber of the management board of Patient@ tures of the healing process and of new reduce the number and duration of ad- home, for a chat about the prospects of wounds, if any, with their smartphone missions to Danish hospitals, due to the the project. The conversation quickly fell and send them to the therapist, who can patients’ active participation and respon- on the design of the future health sibility for own treatment. In more sector and how technology, research concrete terms, this means that and innovation can solve many of healthcare technology can support the demographic and resource chal- patients and reduce pressure on the lenges that we as a society will meet We must find other ways of healthcare sector in three different in the coming years. Peder Jest says: supporting especially the fields: (1) before hospitalisation or outpatient treatment at the hospital - The group of older people in Den- elderly . Starting with the large – such as observation of the citizen’s mark is rather big, and we expect healthcare and innovation pro- physical condition; (2) during treat- more and more in-patients and hos- ject, Patient@home, the goal is ment, in preparation for discharge pital-based treatments, but we do to involve patients much more to own home; and (3) after early not have enough financial resources discharge or outpatient treatment and not enough staff to meet these in terms of treatment and reha- – such as continued observation requirements, and we must there- bilitation, so that the patient’s of a patient’s health status and in fore find other ways of supporting own role becomes much more connection with assisted rehabili- especially the elderly. Starting with obvious and necessary . tation. I asked Peder Jest how a re- the large healthcare and innovation search and innovation project like project, Patient@home, the goal is Peder Jest, Medical Director, Patient@home can be implemented to involve patients much more in Odense University Hospital in Danish hospitals, and what it re- terms of treatment and rehabilita- quires in terms of technology: tion, so that the patient’s own role becomes much more obvious and - When we talk about future hospi- necessary. The goal is to treat a large tals and patients, we have already group of patients as outpatients or started to create the new setup. The directly in the patient’s own home. To then remotely monitor developments. new, large OUH is being erected on the realise this scenario, we must develop re- New homes for elderly have high-tech southern outskirts of Odense. Today, an lated technologies and improve the many fall alarms and sensors in the floors that empty field, but in seven years’ time the digital healthcare solutions currently can alarm nursing staff if a patient falls empty field will have been transformed available. The technology must be use- in the home. New technology can detect into a new university hospital covering ful, and we must tell both patients and patient fluid loss by means of sensors in 224,000 m2. The number of beds in the non-patients that it is ok to be assisted bedding textiles. Many of us have a pe- new hospital will be less than we have to- by technology and that it can be a direct dometer or an app that measures our day, so outpatient treatment – for exam- collaboration partner. The technology physical activity and stores the data on- ple in own home – will be both ordinary should lead us as citizens to take respon- line. Others have a heart-rate monitor or and necessary but also beneficial in sev- sibility for our own treatment, because WI-FI-connected scales that both save eral ways. Some patients experience e.g. the technology helps us and makes things and transmit data on body weight and that a telemedicine video consultation easier in our everyday life. A patient or body-fat percentages. And with the latest with the same doctor every time provides a healthcare system that uses technology Bluetooth technology we can both detect a higher sense of nearness than a consul-

patient@home 29 tation at the hospital, where patients see invite new companies to participate in a new doctor every time; and the video the continued cooperation work. There consultation that takes place in the pa- is still a major technological-commercial tient’s drawing room can be watched and uncultivated field here and it should be listened to by family members. In addi- exploited. tion, the patient saves both waiting time at the hospital and transportation time Results must be brought to light and costs. But the technology must be and Patient@home will set the far more sophisticated than just a secure agenda video connection. And this is where Pa- When the Patient@home project assess- tient@home will make a difference, says es current achievements and presents Peder Jest. new knowledge and advanced technologies, including this publication, it is also 40 emerging technologies about setting the agenda and influence The aim is to make the various project behaviour. Peder Jest explains: partners develop at least 40 new products and services during the life of Pa- - A project like Patient@home is real- tient@home, and the must be developed ly important because doctors and other according to user needs and user accep- healthcare personnel can follow the de- tance. It is also a requirement that all results are based on both the latest research and the hospitals’ development plans and requirements. Patient@home has prepared The philosophy of Patient@ an innovation model that supports home is that the patients must the development of new technologies. The innovation model ensures take responsibility for their that the new technology works and own health . But it does not makes a difference to the end user. have to wait till the damage Peder Jest explains: has occurred and the lifestyle Illustration: New Odense University Hospital (OUH) - Seen from a business point of view diseases have been recognised . both the innovation model and the As a doctor, I would prefer that focus on the end user are extreme- people stayed health because ly important as well as the overall of improved self-care . we are only interested in solutions that business case involving at least 40 solve our problems, and we only benefit new technologies. When we reach Peder Jest from the most beneficial technology, Ped- 2022 and the new OUH (Odense er Jest concludes. University Hospital) is opened as Denmark’s largest hospital built from velopment of our results. It is also im- We must think differently in the scratch on an open field, we hope that portant that the staff that will be working future many of these new technologies will have at the New OUH have the right compe- In relation to the issue of how to in- been implemented in close collaboration tencies. Patient@home can indirectly help fluence behaviour, then Patient@home with the project’s business partners, Ped- to educate people to the future hospital makes high demands on the capability of er Jest says and continues: services as the project is basically about the technology as well as the cooperation three things: To contemplate new ways of the individual patient. But Peder Jest - Patient@home provides Danish compa- of cooperation across disciplines in order would prefer that we went even further: nies with access to the latest knowledge, to reach new targets and new behaviour. laboratories and real-life test facilities. And the very ethnology of Patient@home - Yes, Patient@home focuses primarily This gives the best starting point for is of great interest to me. For example, on treatment, but we should not forget building strong international market po- when doctors, researchers, software de- all the prevention efforts. In addition sitions in terms of innovative and intelli- velopers, engineers and business people to the chronic, non-contagious diseases, gent healthcare technologies and services. work together to find new ways to orga- which can be treated via the Patient@ This is in Denmark’s interest, and in the nise our society, we actually create some- home strategies, I would like far more project’s “second half” we are ready to thing; we build something together. And preventive efforts. The philosophy of

30 patient@home FUTURE Illustration: New Odense University Hospital (OUH) The Patient@home project will run until the beginning of 2018 and will until then focus on the ongoing research and innovation projects, but will also start Patient@home is that the patients must ing technology to collect data about our up new projects that can benefit from take responsibility for their own health. physical state. Some would rather live the platform’s team of scientists, engi- But it does not have to wait till the dam- in blissful ignorance, but I am sure that neers, doctors and other healthcare and age has occurred and the lifestyle diseas- many patients such as those we treat for administrative staff. In this way, pri- es have been recognised. As a doctor, I several chronic conditions would rather vate companies will get an opportunity would prefer that people stayed health have done without these conditions, Ped- to open up new markets and meet new because of improved self-care. A popula- er Jest concludes and continues: partners from other sectors; hospital tion that takes care of itself is one of the partners will get a chance to influence demographic solutions that have been - Patient@home is about technology-as- the development of new technology mentioned so often. It is very a simple sisted treatment, monitoring and reha- and the future healthcare sector; and way of putting things, yes, but it is true bilitation in the patient’s own home. A the Danish municipalities will get a nonetheless. Technology can accomplish future project could be called Citizen@ change to follow the development and much, and we must not be afraid of using home, and here we could look at how maturation of the technologies and it when it can make a difference. In Pa- people can be encouraged to take care services that will be part of tomorrow’s tient@home we are testing more than 70 of themselves and continuously make the healthcare sector at close hand. new technological solutions, and many best possible decisions about their own of these can also be used in a preventive lives and health. And the technology way. When we as citizens and patients must support us and ensure independent become aware of what technology can living, Peder Jest says. do then I think we will take more responsibility for ourselves, because we are us-

patient@home 31 INFORMATION AND KNOWLEDGE MANAGEMENT

Information and Knowledge Management (IKM) plays a central role in many Patient@home activities .

32 patient@home By Uffe Kock Wiil Professor at The Maersk Mc-Kinney Moller Institute, University of Southern Denmark Project Manager and Research Director in Patient@home and a Board Member of Patient@home

The primary aim of IKM is to make The overall philosophy is to work closely Clinical decision support focuses e.g. on: knowledge more accessible to everyone. with end users and interact with them, • Identification of high-risk patients IKM covers various aspects (including in order to identify potential new IKM • Early detection of deterioration in pa- “big data” aspects) in relation to collect- tools and techniques that can help users tients’ conditions ing, monitoring, structuring, integrating, by supporting and/or automating differ- • Analysis and visualisation of data for interpreting, analysing, and visualising ent (routine) tasks related to their data, healthcare professionals health data. information, and knowledge. Field studies and user studies (user involvement) Integrated health platforms focus e.g. on: Patient@home has uncovered a great po- are important parts of this work. • Patient overview of own health tential in terms of improving the use of • Motivating patients for rehabilitation the health data already available at hos- IKM activities in Patient@home can be • Sharing information among patients pitals, municipalities, and general practi- divided into two categories: clinical de- (and relatives) in social networks tioners. We have often heard health pro- cision support and integrated health plat- fessionals say that they believe that they forms. do their job well, but that they could do it even better if they had the opportunity to exploit existing health data more efficiently.

The objective of the IKM area in Pa- tient@home is to work closely with end users (health professionals as well as PATIENT@HOME ILLUSTRATED patients and relatives) with the aim of developing useful software tools such as tools for clinical decision support, which Kirsten (68 years) can assist healthcare workers in perform- ing faster and/or more efficiently, and Some months ago I was acutely data to a computer at the hospital . integrated health platforms that enable hospitalised with atrial flutter and From this data, doctors found out patients (in interaction with relatives and discharged a few days later – with- that I probably had sleep apnoea, healthcare staff), to care better for them- out a clue to what was wrong – the which might be one of the causes selves (“patient empowerment”). doctors could only tell me to take it of atrial flutter, and I am now being easy . Fortunately, I was invited to treated for that . Had it not been for The IKM area thus contributes with join a trial with a heart patch that the new technology and the abili- knowledge and competencies in health continuously measured my heart- ty to measure and collect data and informatics (especially regarding tools beat and some other things . My have them analysed, I don’t think for clinical decision support and integrat- heart data was compiled in a box that doctors would have found out ed health platforms), information and that continuously transferred my yet what was wrong with me . knowledge management (including data mining and machine learning) and software engineering (development of software tools).

Information and knowledge management 33 ACQUIRE-ICD

A telemedicine project that will develop and test the clinical and economic impact of an interactive, integrated, web-based platform that can improve the quality of care of patients with heart disease implanted with an ICD

The incidence of heart failure is increas- the outpatient clinic. ACQUIRE-ICD their disease and their device, explains ing, and in Europe and the United States represents a highly innovative and sus- Susanne S. Pedersen. alone more than 26 million are affected tainable paradigm shift, as it relies on pa- annually resulting in over one million tient-centered and personalized tools to The Livalife platform will be used and admissions. Heart failure is a complex, empower patients, with these tools cou- adapted to the ACQUIRE-ICD project chronic condition in which the heart pled to a novel web-based and interactive and can also be used via an app. muscle is weakened and unable to effi- platform that is also available via an app. ciently pump blood around the body. In This approach has not been tried so far, - Liva Healthcare ApS is very pleased that order to prevent sudden cardiac death, says Susanne S. Pedersen. the project has chosen to rely techno- many patients with heart failure are im- logically on our platform, which is also planted with an implantable cardioverter Widespread integrated platform available as an app. Experiences from defibrillator (ICD). The disorder causes to increase ‘patient empower- the project will significantly contribute disability, depression, and reduced qual- ment’ to making our product even better, says ity of life due to fatigue, shortness of The goal of the ACQUIRE-ICD platform Kristoffer From, CEO from Liva Health- breath and fluid retention, and the risk is to make patients with heart disease and care ApS. of hospitalisation and mortality is high. an ICD able to routinely monitor their health status and symptoms of anxiety Focused design process with the The ACQUIRE-ICD project will develop and depression and detect deterioration user and test an interactive, integrated, web- at an early stage. Via the platform pa- The contents for the platform are being based platform for facilitating timely tients will be able to engage in a dialogue developed using a user-centred design detection and treatment of patients with with health care professionals, enabling involving both patients and health-care heart disease and an ICD in a multi-cen- action plans to be set up that are support- professionals. In the fall of 2016, recruit- tre randomised study. ed with hands-on advice and tools pro- ment of patients for the study will com- vided via the platform or app. Patients mence in order to examine the clinical Professor Susanne S . Pedersen, Pro- will also have the possibility of engaging and economic efficacy of the intervention ject Leader and Initiator of the project, with other patients via the platform. in a multi-centre randomized controlled Department of Psychology, University of trial. Southern Denmark, says: We want to give patients a more active We are faced with the challenge of provid- role as advocates of their own health Project partners ing good quality of care to this increasing in a medical decision-making process, The ACQUIRE-ICD team is multi-disci- population of patients, while the health- while enabling treatment recommenda- plinary and international and consists of care system is challenged on its resources. tions and advice to be tailored to indi- experts from the University of Southern We know from clinical practice that it is vidual patients’ needs and preferences. Denmark, Aalborg University Hospital, difficult to pinpoint exactly when things We expect that this will increase patient Odense University Hospital, Aarhus start to go wrong for these patients, also empowerment, compliance, treatment University Hospital, CIMT, Liva Healthcare since practice has changed and almost all satisfaction, and quality of life, and may ApS, and Saint Luke’s Mid America Heart ICD patients are placed on remote mon- help prevent hospitalisations and overall Institute, USA . itoring, reducing the number of visits to enable patients to live a better life with

34 patient@home PATIENT@HOME ILLUSTRERET

Svend (68 years) I have a bad heart, to put it bluntly . ious or afraid, and the system can I’ve visited my own doctor regu- inform the healthcare team in due larly for check-ups and been ad- time, if something is wrong and I mitted to the hospital cardiology am in need of medical assistance . ward many times . Having the diag- For me all this means that I’ve nosis I have, one takes one day at got a swift and flexible tool that a time, trying to make the best of helps me in my everyday life . That the situation and live a good life . I am being monitored continuously This summer I joined a project that means that I sometimes can avoid runs over the Internet . It’s simply an emergency trip to the hospital about making me able to keep an because the symptoms are either eye on my own health and detect due to anxiety or false alarm . All deterioration at an early stage . At in all, my course of treatment has the same time the system gives become much more flexible than me the opportunity to get in con- before, the review is faster and I tact with a heart-failure healthcare avoid many hospital admissions . team, if I need advice and feel anx-

Information and knowledge management 35 IDENTIFICATION OF HIGH-RISK PATIENTS

Information and knowledge management in practice at Odense University Hospital

Up to 30% of patients arriving at the deterioration. Many systems have been Camilla and Thomas tell about the status emergency department (FAM) at Odense developed to monitor patients, but it of the project: University Hospital (OUH) with vital remains uncertain whether a systematic - We have at this point in time collect- values in the normal range, experience monitoring of emergency patients will be ed data on all patients during the study deterioration within the first 24 hours able to contribute sufficiently to reduce period. The material consists of anony- when values exceed normal limits. the risk of death or transfer to intensive mised personal data and data on clinical care units. There is, therefore, a need for and developed conditions over a 2½- On arrival at FAM the severity of the establishing a better overview of patient year period on all emergency patients condition of the patients is assessed and characteristics and the development of arriving and admitted to the Emergency all patients are assigned to one of five co- the different measurements taken over Department at OUH. The technical part lour-coded triage categories red, orange, time as well as a need for systematic of the project is structurally spread over yellow, green and blue. The challenge knowledge of the prognostic value of the following three items: organisational with this approach is that a number of these measurements and change patterns. understanding, modelling of patient care, patients are unnecessarily assessed as and design of clinical decision-supportive high-risk patients, and that the condition The vision prototypes. Throughout both the quali- of patients, who basically were not as- The project’s goal is to provide health- tative and quantitative studies, we have sessed as high-risk patients, suddenly and care professionals at Odense Universi- defined a number of challenges for both unexpectedly deteriorates. ty Hospital with new opportunities to staff and patients, which we are now try- identify FAM patients with deteriorating ing to resolve. Patients with unexpected deterioration in vital parameters. This is done by identify- their clinical condition have significantly ing risk factors associated with death or Professor Uffe Kock Wiil, Project Manager increased mortality and risk of transfer transfers to intensive care and developing and Research Director of Patient@home, to the hospital’s intensive care unit. This new technological models that can pre- talks about the project cooperation: scenario in combination with FAM’s gen- dict and warn of potential life-threaten- - There are many exciting prospects in eral challenges such as varying resource ing complications before they occur. The the project. The overall vision of the requirements depending on the number approach to the project is largely based project is that it can contribute with new of patients and varying severity of their on the need for interaction between us- knowledge that can form the basis for de- condition, many different categories of ers, patients, and organisation and infor- cisions about the kind of patients that we patients, who often need to be assessed mation technology. need to keep better track of. Ultimately, by a specialist from other hospital de- this should result in fewer complications partments, and a high volume level from The project’s PhD programme is run as a and shorter hospitalisations. The inter- alarms – also sometimes false alarms – twin project in close collaboration with action between health science and tech- results in a situation that highly stresses software engineer Thomas Schmidt and nical research allows for a more holistic the personnel and increases the risk of medical consultant Camilla Nørgaard approach to the problem. The interdis- errors occurring. Bech. They cover the clinical and techni- ciplinary cooperation between Camilla cal angles of the project and are thus a and Thomas is certainly enriching both Attempts have been made, for several good example of the outcome of building PhD projects. years, to develop the optimal tool for bridges between clinical and technical ex- healthcare professionals, which they pertise, which is important for Patient@ can use to identify patients at risk of home.

36 patient@home between fitness goals, exercise, and disease development 3. Self-management tools for disease management, knowledge of side effects and risk factors, chat and online communication with health professionals

Professor Uffe Kock Wiil, Project Manager and Research Director of Patient@home, talks about the project’s international dimension: - DiabeticLink Denmark is a good example of fruitful international cooperation under the auspices of Patient@home. University of Southern Denmark has had good relations with University of Ari- DIABETICLINK zona over the last 5 years. This project will cement this collaboration. It’s exciting that we in Denmark can be part of a large international project that includes DENMARK countries such as USA and Taiwan. Dia- beticLink Denmark wants to build bridg- Development of an online health network for es between the powerful big data skills of people with diabetes the University of Arizona (and CIC) and the good Danish tradition of involving Diabetes is a chronic and costly disease ticles on health, and the opportunity to users in the development and adaptation for the individual as well as for society. participate in online support groups. The of systems. According to the WHO, the diabetes objective of DiabeticLink is to increase treatment costs will rise sharply in the patients’ motivation for participating in Consultant Ana Maria d’Auchamp, Danish coming years as a result of the demo- management of their disease, including Technological Institute, tells about the graphic and socio-economic develop- the establishment of a strong network project cooperation: ment in many parts of the world. In Den- around the patient, consisting of family, - To investigate how a system developed mark, the number of diabetics and the doctor, and other patients. for other users can be adapted to Dan- costs of diabetes care are also expected to ish needs, has been extremely interesting, increase steadily. Good diabetes control The Patient@home project DiabeticLink also how our expert knowledge on Dan- can save the individual for disease pro- Denmark (DL-Denmark) is a Danish ver- ish users has been successfully combined gression and development of complica- sion of DiabeticLink, the aim of which with the US team’s technical knowledge tions. Ensuring the right balance between is to adapt the DiabeticLink platform to for the development of a new solution. diet, physical activity, medications, and a Danish context, based on the needs of It is a good example of global product blood glucose value requires knowledge, Danish patients. A survey of user needs development and innovation. motivation, and new tools. and customisation of the platform was carried out by the Danish Technological The project partners are: DiabeticLink, developed by the compa- Institute. Danish Technological Institute, Center for ny Caduceus Intelligence Corporation Working Life (CIC) and Artificial Intelligence Lab at DiabeticLink covers three areas: The Maersk Mc-Kinney Moller Institute, the University of Arizona, is an online University of Southern Denmark health network and tool that help peo- 1. Patient support via social media Artificial Intelligence Lab, University of ple with type-1 and type-2 diabetes to platform – peer-to-peer support, user Arizona take responsibility for their own health blogs, and discussion forums Danish Diabetes Academy – JDRF and disease through new knowledge and 2. Patient education – information Pragmasoft A/S communication with other diabetics. The on diseases, diabetes knowledge Steno Health Promotion Center DiabeticLink platform includes easy con- resources (treatment, medication, Region of Southern Denmark, Health In- tact to the doctor’s, access to the latest diet, everyday life, recipes), and the novation Centre of Southern Denmark knowledge about diet and nutrition, ar- opportunity to see the connection Caduceus Intelligence Corporation (CIC)

Information and knowledge management 37 INFORMATION AND COMMUNICATION TECHNOLOGY (ICT)

One of the most basic requirements for enabling telemedicine treatments or consultations by use of modern technology is the availability of an Information and Communication Technology system (ICT) .

38 patient@home By Lars Dittmann Professor at the Department of Photonics Engineering, Technical University of Denmark Work Package Leader for the ICT area in Patient@home

The Internet has become widely available for handling NEM-ID, which is a com- tem and on standardised principles, in and the coverage much better, especially mon log-in solution for Danish Internet order to avoid development of something as a result of the expansion of the mobile/ banks, government websites and some that is the target of one patient group or cellular networks. But no single technol- other private companies). one type of equipment. ogy can support all the requirements expected by an efficient deployment of And finally, it is important that telemedicine services. the user/patient/citizen is involved and committed as much as possible High availability – meaning that the and that use of the patient’s own network is always accessible and It is important that we continue equipment and the data collected functioning – and private/secure to develop new and better through the established health sys- communication are usually not re- telemedicine solutions that tem – for example, when linking quirements demanded by users of users are comfortable with self-monitoring equipment with today’s most commonly used Inter- various private gadgets – is secured net applications, but it will be in re- (and which they trust will work and applied in compliance with the lation to advanced e-Health applica- whenever they need them) patient’s own wishes. Data that was tions. And while private users might without compromising on collected via self-monitoring before accept charging their smartphone security the user became a patient may, be- every day, the power consumption cause of its complexity, prove to be of medical sensors and measuring worth its weight in gold in relation equipment will play an important to a certain treatment if it is under- role when a new energy-efficient technol- To create such a degree of accessibility stood and processed correctly. ogy solution is to be selected. by means of a single technology is generally both difficult and costly, and will Believing that such a task can and must Ensuring high availability in relation also mean higher costs and less usability be lifted by large international companies to maintenance cost/purchase price is a of applications which do not need these only may prove very unfortunate in the complicated issue. While off-line meas- qualities. But that is the reason why we long run in terms of patient safety and urements, for example on weight, blood conduct research in telecommunication confidence in the system – and thus the pressure and lung capacity, can endure and information and communication patients’ enthusiasm. some delay (caused by e.g. overloading systems. or poor coverage by the ICT system) In “Patient@home” a number of differ- before being transferred and registered It is important that we continue to devel- ent solutions are being investigated in by the telemedicine health system, re- op new and better telemedicine solutions relation to secure and user-friendly com- al-time monitoring and alarm systems that users are comfortable with (and munication with high availability, with (such as case detection, pain related to which they trust will work whenever the broader purpose of examining the heart/vascular diseases) require an ICT they need them) without compromising possibility of making the patient mobile, system that is available with a minimum on security – and simultaneously develop so that the patient can be monitored and probability of typically 99.999%. This is solutions that users find easy to use. offered assistance outside own home, e.g. similar to the Internet failing maximum in the car, in the garden, when visiting 5 minutes per year (“five-nine” – which Cost wise, it is also important to base family and friends. is actually 100 times better than required telemedicine solutions on a general sys-

Information and communication technology (ICT) 39 ADAPTIVE SOFTWARE PLATFORM FOR TELEMEDICINE

An innovative Patient@home project focusing on the development of an adaptive software platform for telemedicine will enhance future telemedicine solutions to home monitoring and home care

With new state-of-the-art information - An overall requirement from Patient@ Intelligent use of data and communication-based technologies home is that it must be easy for applica- The platform’s last component is the rea- (ICT), it is possible to optimize treatment tions and technologies to integrate to the soner that should make it easy for citi- in the Danish hospital sector by linking infrastructure/platform developed in this zens to use the platform. This component traditional treatment with technolo- project. When ensuring easy integration, is not developed yet, but it is the focus gy-enhanced home monitoring and home the data input layer comes into play. It of the remainder of the research project. care. However, ensuring a high quality of is a library developed in Java which has Daniel Bjerring Jørgensen explains: treatment of patients in own home, still to be included in the systems that want requires solutions to many of the chal- to send data to the platform. The only - The Reasoner component shall incor- lenges that are related to software sys- thing needed to send data to the plat- porate intelligence into the platform. The tems in telemedicine – both in relation to form via the library, is a method call with starting point is that citizens act differ- collection and processing of health data appropriate parameters to an object in ently and that telemedicine systems im- and in relation to exchange of data with the library (a temporary agent is creat- plemented in their homes must therefore other relevant systems in healthcare. ed automatically). Then the underlying also be able to act differently. To this end, infrastructure handles all the necessary the reasoner will use user modelling, to Data collection technicalities. ensure that the platform says the ‘right’ Generally speaking, this Patient@home thing at the ‘right’ moment and in the project aims to develop an ICT infra- - Our platform is a multi-agent system, ‘right’ way. The platform will simply be structure consisting of a number of which is a programming paradigm that able to adapt to the patient’s preferences, components that support collection and was previously known as distributed ar- habits and physical abilities. intelligent use of data. The project is tificial intelligence. The basis of agents’ developed as a PhD project with Daniel communications is described in an on- Our work will concentrate on under- Bjerring Jørgensen at the helm. Two out tology which is a method to abstractly standing the citizen’s habits to ensure that of three years of studies have been com- describe all the knowledge that may be the system does not interfere at inappro- pleted and the foundation for a generic available and exchanged between soft- priate times. For this purpose, we have and open software platform developed. ware components of artificial intelligence obtained a data set from a smart home The platform consists primarily of three systems. The ontology developed in this that for several months continuously col- components: Data input layer, ontology project describes the example data from lected information about the resident’s and reasoner, of which the first two are measuring equipment (pulse, blood pres- behaviour. We will then try to develop fully developed. sure, etc.), smart home (falls, motion sen- an algorithm that is able to predict the sors, etc.) and data on the citizen’s phys- resident’s behaviour the next day so that PhD Student Daniel Bjerring Jørgensen ical activities and daily routines as well the platform can schedule reminders etc. from the University of Southern Denmark as a number of other types of data that says: relate to “the patient”.

40 patient@home Our models of care must change – investing in prevention of disease; delaying the point at which disease becomes acute; and transforming hospitals from destinations to become nodes of expertise in a network of care that includes the home and work . The Patient@home programme is very important in providing research and transla- tion of inventions to innovations that can be adopted at scale across health and social care systems in Denmark, Scandina- via and beyond . #Kevin John Dean (Managing Director, Smart Health Science Ltd., a member of the advisory board of Patient@home)

PATIENT@HOME ILLUSTRATED

Expected results The general objective of the project and Jesper – family member of the expectations of the new technology are that the developed adaptive software Johannes (81 years) platform will strengthen the future of telemedicine solutions’ focus on the indi- As a family member, I must say various technical devices, such as vidual patient, and thus help to improve that the new technology gives us smartphones, motion sensors and the quality of care in general. a real sense of security in our ev- intelligent bracelets . This means eryday life . My father has incipient that doctors, nurses and caregivers The project has been developed at dementia and a genetic predisposi- can keep track of his well-being . It The Maersk Mc-Kinney Moller Institute, tion to blood clots . But he is still so makes us feel safe and near him, University of Southern Denmark . fresh that he can take care of him- even though we don’t constantly self at home . He is participating in drop by his house to see how he is a study that gathers information doing . We know that the experts about his heart-beat rate, blood keep an eye on him . pressure and place of stay using

Information and communication technology (ICT) 41 FAST TRACK

Fast-track projects provide special opportunities for faster testing

42 patient@home By Claus Duedal Pedersen Senior Consultant at Odense University Hospital (OUH) Work Package Leader of Fast Track in Patient@home

Many Patient@home projects require taking further development or commis- number of patients (20-30). Testing is extensive research and close cooperation sioning decisions. then carried out in the course of two or among several parties e.g. the project three months, followed by a rapid evalu- Hospital Home. They need several years Fast-Track projects can also be built on ation that covers all domains of the Pa- of planning and execution of tests, before technologies that have been implemented tient@home innovation model, but has any conclusions can be drawn and con- and tested in one area and then subse- no definite scientific level. crete solutions made available. Another special feature of Fast- Another group of projects in Pa- Track projects is the active partic- tient@home goes under the name of The basic concept of Fast Track ipation of the technology supplier. Fast Track. As the name suggests, This ensures project implementa- these projects are characterised by is that a department finds a tion with a high degree of support being quickly initiated and imple- new technology that is relevant and attention. It also means that it mented. Typically, the entire project to the workflow and consid- is not possible to get a true picture period is 3-6 months. Fast Track ered likely to be beneficial on of the operation of IT systems, but it projects are anchored in CIMT ensures a test that is “undisturbed” – Centre for Innovative Medical either a clinical, economic or by technical problems and that it is Technology (OUH/SDU) – since patient-related level . the clinical situation and use that OUH has both specific opportuni- are assessed. ties and interests in using Fast Track projects in relation to testing and Overall, the Fast-Track concept has evaluating different technologies that can quently been deemed beneficial for other proved to be extremely useful. There are modify and optimise workflows. areas of the healthcare sector. solutions that have been rejected and solutions that have been put into opera- The Fast-Track projects do not focus on Finally, there may be completely new tion after a Fast-Track process. It should development of new technology, but on technology areas where OUH can carry be stressed, though, that rejected projects testing the technology in a clinical con- out fast pilot tests and get an evaluation are at least as successful as those that text, or on implementing a specific tech- of the potential of the technology, such as have been approved. Being able to quick- nology with proven efficacy in a clinical the trial of the Google-Glass technology ly reject a solution, which does not pro- setting. Activities related to these tech- for visualisation and hands-free commu- vide winnings and are based on practical nologies may have occurred for a long nication. tests, is of great importance to a large time in another context, such as a long- organisation like OUH. term research or development project, The basic concept of Fast Track is that a but now the final push towards actual department finds a new technology that implementation is needed. In these cases, is relevant to the workflow and consid- the possibility of carrying out a Patient@ ered likely to be beneficial on either a home Fast-Track project means addi- clinical, economic or patient-related lev- tional resources can be made available el. On that basis, a minor pilot project for further clinical testing, research and will be implemented, typically compris- development. It also creates a basis for ing a few members of staff and a small

Fast Track 43 TESTING OF GOOGLE GLASS AT OUH

Project participant Mikkel Scherfig Straarup, nurse at the Emergency Department at OUH

Fast-Track Project on the use of advanced new technologies related to fast patient courses

The purpose of the project was to test released on the market. tors with a visual input (CTG-curve) as Google Glass (GG) as a useful tool in an addition to a verbal description when clinical work situations at Odense Uni- GG was tested in two departments at a midwife had to contact a doctor en- versity Hospital – and to examine wheth- Odense University Hospital: The Emer- gaged in an operation for advice regard- er it is technically possible to use the GG gency Department (FAM) and the De- ing a patient at the maternity ward. in conjunction with clinical systems used partment of Gynaecology Obstetrics D in patient care, and to clarify whether (Gyn. Obs. Div.). GG was used 23 times Results GG, which can be operated hands-free, in the pilot project, 12 of which were The pilot project has found positive in- can be a useful tool in the clinic. without the involvement of patients and dications for the use of GG in clinical 11 with involvement of patients. settings in terms of observations, user The project ran from 1 May 2014 till evaluations and verbal feedback by users 15 January 2015 and was carried out At FAM, the spectacles’ “see-what-I-see” and project participants. together with the company Accenture, live streaming function was used to pro- which had an agreement with Google to vide doctors or nurses with advice from Project Manager Claus Duedal Pedersen try out the Google Glass technology in more experienced colleagues who were from Odense University Hospital says: Denmark, and thus made it possible to not present at FAM. On Gyn. Obs. Div. - Google Glass is estimated to provide a get hold of the technology before it was GG was used to provide operating doc- quality boost and time savings. At Gyn.

44 patient@home Obs. Div. the participating clinicians all ogy, Odense University Hospital’s De- said that the CTG curve shown on the partment of Gynaecology Obstetrics, In- GG was a useful and valuable addition novation Network RoboCluster and the It is a goal to the description in words and gave a company Accenture. that many more nuanced basis for decision-taking. more patients will In addition, immediate decisions from Project Manager in Innovation Network operating physicians reduce the need for RoboCluster, Conny Heidtmann, high- be treated as outpatients in their following up on postponed inquiries af- lights: own homes . Therefore, an innova- ter surgery. As for the “see-what-I-see” - Accenture conducted a workshop at tion model has been established mode on FAM, the clinicians indicated OUH attended by clinical staff from in the auspices of Patient@home that it is useful and provides clinical val- various departments. Accenture gave a which ensures that prototypes ue. The use of GG means that decisions presentation and demonstration of GG, and products are based on iden- can be taken even though the consul- and the workshop resulted in a number tative party is not physically present at of scenarios that clinicians had outlined, tified and clearly described needs FAM, and it therefore saves time by not and in which Google Glass could make and challenges among users and having to wait for their presence. a difference in the clinicians’ daily work customers – at both regional at the hospital. Two of these cases were and municipal levels . The model The project has also met several technical subsequently selected for the pilot test. also ensures that the results are challenges including battery life, using validated in clinical and user-close own glasses together with Google Glass, RoboCluster’s role in the project has been as well as safeguarding the clinical data to invite Accenture to participate in Pa- environments, and that new ideas transmitted via the technology, which tient@home, where the pilot test should are based on solid research and prevent immediate implementation of a take place, and to ensure that the results close involvement of both compa- technology like Google Glass. These rea- of the pilot test were widely disseminated nies and end users . sons are exactly the same as identified by to relevant players within the healthcare # Jørgen Løkkegaard (Centre Manager, other professionals who have tested GG, sector and among other stakeholders. It Danish Technological Institute, and that is also why Google has removed will be interesting to see how and when (Innovation Leader in Patient@home GG from the market – at least for the wearable technologies will make their en- and a Board Member) time being. try into the healthcare sector for the benefit of both patients and clinicians. There was, however, so much potential in the tested features that OUH will continue to follow the developments of the PATIENT@HOME ILLUSTRATED so-called ‘wearables’, which allows for hands-free operation and direct connection to networks and clinical systems Ruth (61 years): that can be of great value in the clinical workflow. A few years ago my sister was di- it doesn’t affect my daily living . agnosed with osteoporosis after I have joined an exciting project Since the pilot test of GG only focused she fell and broke her hip . She had called Mobile Health Technology on testing GG as a tool, complex inte- always been a heavy smoker and for women with osteoporosis . The grations with key clinical systems were underweight, and the doctor told project helps me understand what not taken into consideration. However, her that the disease is both he- the diagnosis means – both in the project’s simple tests gave indications reditary and life-style dependent . terms of medical treatment and in that may be followed up by larger tests, One day I pulled myself together relation to needed intakes of cal- including system integrations, if other and went to the doctor’s, who re- cium and vitamin D – and what it similar wearable technologies should referred me to the hospital for a scan takes to live bone-friendly . I have quire testing. Subsequent studies or trials that measured my bones’ mineral great pleasure in participating in at OUH will also have to gather evidence content and density . The diagnosis the project, and I suddenly un- and greater experience to document pos- was osteoporosis – brittle bones . derstand what self-care actually itive effects on clinical workflows and Fortunately, it was discovered be- means for one’s well-being . parameters. fore any fractures occurred, and

The project is a collaboration between Center for Innovative Medical Technol-

FastmTrack 45 PROJECT PARTNERS

Companies Pallas Informatik A/S Absolute Liquid Solutions ApS PlayAlive A/S Accenture PlayScapes Denmark ApS Access Technology ApS Pragmasoft Astrid Leisner & søn Robotic Ultrasound ApS Bandagist-Centret Safecall Denmark ApS Caduceus Intelligence Cooperation SENS Innovation ApS Cambio Healthcare System A/S Sensor Medical A/S Capgemini Danmark A/S Systematic A/S Care Excerciser Teccluster A/S Cekura A/S Tele Call Danmark CGI Ther-Ex CIM Gruppen A/S TriVision A/S DorsaVi Ltd. Tunstall DoseSystem ApS Viewcare A/S Eglu A/S Welfare Denmark ApS Entertainment Robotics Yes Group Ergolet ApS Evidence Profile ApS Universities ExorLive A/S University of Southern Denmark GN Store Nord A/S Aalborg University Hospitalet Valdemar A/S Technical University of Denmark IBM University of Copenhagen ICURA Aarhus University Induct Software A/S Osaka University Izinga Advanced Telecommunication Research KMD Life-Partners A/S Innovation Partners Lindpro A/S Welfare Tech Medema A/S Danish Technological Institute Medicomb A/S Health Innovation Centre of Southern Denmark Medisat A/S DELTARoboCluster MedWare ApS Idéklinikken Mobile Fitness A/S Move Innovation ApS Hospitals/Municipalities MV-Nordic Glostrup Municipality NETOmsorg ApS Odense Municipality Nico Design Aarhus Municipality OSAA Innovation Næstved Municipality Pacini Medico Odense University Hospital

46 patient@home PROJECT OVERVIEW

Rehabilitative Training - Ecology of Care: Human-centred Care to be  Included in the Concept of ‘Care’ - Home Training of Neck Pain Radiating into the - Telemedicine for Patients with Hip Fractures Arm - Digital Help for Citizens with Back Fractures - Sensors for Neck-Pain Training - Implementation of Electronic Medication - Game Technology for Rehabilitation Administration in the Citizen’s Own Home - Motivation of COPD-patients - Test and Documentation of a Mechanical IV Bag - Digital Support of Clinical Documentation Pump - Rehabilitation with Industrial Robots – Universal - Early Detection and Reduction of Relapse in RoboTrainer Social Psychiatry - RoboTrainer Light - Kidney Transplantation, Involvement and - Rehabilitation of Brain Damage mHealth - Intelligent Headset for Neck Training - Efficient home rehabilitation tool SENS motion®  Information and Communication Technologies (ICT) Monitoring  - Adaptive Software Platform for Telemedicine - Evaluation of KMD System - Secure and Reliable ICT Systems for Telemedicine - Innovative Technology Used for Treatment of Applications Wounds - DoloTest® - Helping People with Chronic Pain - ACCESS - Coordinated Emergency Efforts for Senior Citizens  Information and Knowledge - Hospital at Home Management - Hospital at Home: Sensor Fusion - Identification of High-risk Patients - Hospital at Home: Computer-vision for in-home - Patient-Centered Tools to Improve Life with medical diagnosis and monitoring Heart Disease - Spiromagic - Electronic Spirometer - DiabeticLink - D-Time – Safeguarding the Everyday Life of - Mobile Health Technology for Patients with Diabetics Osteoporosis - Pain Management Chair - Targeted Drug Information in Community Care - Robotic Telemedicine Ultrasound - RELIP: Reading Between the Lines - Safe-Biopsy: Safe and Efficient Handling of Tissue Samples  Fast Track Care in Own Home - COPD Patients at Home  - Monitoring of Cardiac Function - Chromalex – The Meditative Image - Wireless Screening in the Home of Patients with - Interactive and Socially Assistive Robots Suspected Disturbance of Heart Rhythm - Exoskeleton for the Arm and Shoulder Region - Baby Briefcase for Maternity Parents - Care-O-Bot 3 as a Test Platform and Inspiration - Telemedicine Discharge Planning Conference - Technology for Communication and Relationship - Videoconferencing in Healthcare Building - MAST - Model for Assessment of Telemedicine - Detection of Body Fluid - Video Interpretation for Particularly Vulnerable - Preventing Pressure Ulcers with Patients in Own Patients Homes - Google Glass-testing at OUH - Operating System for People with Reduced - Telemedicine Rehabilitation of Patients with Cognitive Functions Severe COPD

patient@home 47 Photo: Danish Technological Institute