Digital Health: Mobile and Wearable Devices for Participatory Health Applications

217 Pages·2020·6.327 MB·English

by  Shabbir Syed-Abdul, Xinxin Zhu, Luis Fernandez-Luque

DIGITAL HEALTH
Mobile and Wearable Devices for
Participatory Health Applications
Edited by
SHABBIR SYED-ABDUL, MD, MSc, PhD
Graduate Institute of Biomedical Informatics,
Taipei Medical University, Taipei, Taiwan
XINXIN ZHU, MD, PhD, FAMIA
CenterforBiomedicalDataScience,SchoolofMedicine,
YaleUniversity,NewHaven,CT,UnitedStates
LUIS FERNANDEZ-LUQUE, PhD
Adhera Health Inc, Palo Alto, CA, United States
Elsevier
Radarweg29,POBox211, 1000AEAmsterdam, Netherlands
TheBoulevard,Langford Lane,Kidlington,OxfordOX5 1GB,UnitedKingdom
50HampshireStreet,5thFloor, Cambridge,MA02139,UnitedStates
Copyright©2021ElsevierInc.Allrightsreserved.
Nopartofthispublicationmaybereproducedortransmittedinanyformorbyany
means,electronicormechanical,includingphotocopying,recording,oranyinformation
storageandretrievalsystem,withoutpermissioninwritingfromthepublisher.Details
onhowtoseekpermission,furtherinformationaboutthePublisher’spermissions
policiesandourarrangementswithorganizationssuchastheCopyrightClearance
CenterandtheCopyrightLicensingAgency,canbefoundatourwebsite:www.elsevier.
com/permissions.
Thisbookandtheindividual contributionscontainedinitareprotected under
copyrightbythePublisher (otherthanasmaybenotedherein).
Notices
Knowledgeandbestpracticeinthisfieldareconstantlychanging. Asnew research
andexperiencebroadenourunderstanding, changesinresearch methods,professional
practices,ormedical treatment maybecomenecessary.
Practitionersandresearchersmustalwaysrelyontheir ownexperience andknowledge
inevaluating andusingany information,methods,compounds,orexperiments
describedherein. Inusingsuchinformation ormethods theyshouldbemindfulof
theirown safetyandthesafetyofothers,includingpartiesforwhomthey havea
professionalresponsibility.
Tothefullestextentofthelaw,neither thePublishernortheauthors,contributors, or
editors,assume anyliabilityforanyinjury and/ordamagetopersonsorproperty asa
matterofproductsliability,negligence orotherwise,or fromanyuseor operationof
anymethods,products, instructions,or ideascontainedinthematerialherein.
LibraryofCongressCataloging-in-Publication Data
Acatalogrecord forthisbookis availablefromtheLibrary ofCongress
BritishLibraryCataloguing-in-Publication Data
Acataloguerecord forthisbook isavailablefromtheBritishLibrary
ISBN:978-0-12-820077-3
Forinformation onallElsevierpublications visitourwebsite
athttps://www.elsevier.com/books-and-journals
Publisher:Mara Conner
EditorialProjectManager:Isabella Silva
ProductionProjectManager:Prem KumarKaliamoorthi
CoverDesigner: MilesHitchen
TypesetbyTNQTechnologies
Dedication
We dedicate this book to all advocates who endeavor to advance digital
health by empowering consumers, making better-informed health
decisions. To researchers, who are providing new options for facilitating
prevention, early diagnosis of life-threatening diseases, and management of
chronic conditions outside of traditional care settings. We thank them for
theirdedicationtothetransformationofdigitalhealththatensuresequality,
empowerment, and patients’ participation.
v
Contributors
Pamod Amarakoon,MBBS
Postgraduate InstituteofMedicine, Universityof Colombo,Colombo, SriLanka
Jorge Cancela,PhD
F.Hoffmann-La RocheLtd.,Basel,Switzerland
IliàsCharlafti, MSc
F.Hoffmann-La RocheLtd.,Basel,Switzerland
KeiLongCheung, PhD
Department ofHealth Sciences,BrunelUniversityLondon,London,UnitedKingdom
Mohamed-Amine Choukou, PhD
Department ofOccupational Therapy, CollegeofRehabilitation Sciences,University of
Manitoba,Winnipeg,MB,Canada
EmmaA.D. Clifton, PhD
Department ofMedicine, UniversityofCambridge, Cambridge,UnitedKingdom
SeyaColloud,PharmD
F.Hoffmann-La RocheLtd.,Basel,Switzerland
HeindeVries,PhD
ProfessorinHealth Communication attheDepartment ofHealth Promotion, CAPHRI
PublicHealth,MaastrichtUniversity, Maastricht, TheNetherlands
Vajira H.W.Dissanayake,MBBS, PhD
Faculty ofMedicine,University ofColombo, Colombo,Sri Lanka
Noémie Elhadad, PhD
DataScience Institute,Columbia University,NewYork, NY,UnitedStates;Department
ofBiomedical Informatics,Columbia University,NewYork, NY,UnitedStates
IpekEnsari, PhD
DataScience Institute,Columbia University,NewYork, NY,UnitedStates
Roshan Hewapathirana, MBBS,MSc,PhD
Faculty ofMedicine,University ofColombo, Colombo,Sri Lanka
Santiago Hors-Fraile, MSc
SalumediaLabs,Seville,Spain
RobertJarrin, JD
AdjunctAssistant Professor,Department ofEmergency Medicine,GeorgeWashington
University SchoolofMedicineandHealth Sciences,Washington, DC,UnitedStates;
AdjunctAssistant Professor,School ofMedicine-Department ofBiochemistryand
Molecular&Cellular Biology,Georgetown UniversityMedicalcenter, Washington, DC,
UnitedStates
xi
xii Contributors
JuanJoséLull, PhD
InstitutoUniversitario deInvestigacion(cid:1) deAplicaciones delasTecnologías dela,
Informacion(cid:1) ydelasComunicaciones Avanzadas(ITACA), Universitat Politècnica de,
València,Spain
Antonio Martínez-Millana, PhD
InstitutoUniversitario deInvestigacion(cid:1) deAplicaciones delasTecnologías dela,
Informacion(cid:1) ydelasComunicaciones Avanzadas(ITACA), Universitat Politècnica de,
València,Spain
Cecilia Mascolo,PhD
Department ofComputerScience &Technology,University ofCambridge,Cambridge,
UnitedKingdom
KapilParakh,MD,MPH,PhD
AdjunctAssistantProfessor, YaleUniversity Schoolof Medicine,NewHaven,CT,
UnitedStates
IgnacioPerez-Pozuelo, MSc,MS
Department ofMedicine,University ofCambridge,Cambridge,UnitedKingdom
TheAlanTuring Institute,London,UnitedKingdom
Dimitris Spathis,MSc
Department ofComputerScience &Technology,University ofCambridge,Cambridge,
UnitedKingdom
ShabbirSyed-Abdul, MD,MSc,PhD
GraduateInstituteof BiomedicalInformatics, TaipeiMedicalUniversity,Taipei,Taiwan
VicenteTraver,PhD
InstitutoUniversitario deInvestigacion(cid:1) deAplicaciones delasTecnologías dela,
Informacion(cid:1) ydelasComunicaciones Avanzadas(ITACA), Universitat Politècnica de
València,Spain
MohyUddin,MD
Executive Office,King Abdullah InternationalMedical ResearchCenter, KingSaudbin
AbdulazizUniversity forHealth Sciences,MinistryofNationalGuard -Health Affairs,
Riyadh,Kingdom ofSaudiArabia
FeiWang,PhD
Department ofPopulation HealthSciences,WeillCornell Medicine,Cornell University,
NewYork,NY,UnitedStates
Catherine Wu,MSc
F.Hoffmann-La RocheLtd.,Basel,Switzerland
ZhenxingXu,PhD
Department ofPopulation HealthSciences,WeillCornell Medicine,Cornell University,
NewYork,NY,UnitedStates
BinYu,PhD
AmericanAirLiquideInc NewYork, NY,UnitedStates
List of reviewers
DariAlhuwail CollegeofLife Sciences,KuwaitUniversity,Kuwait
RosaBaños UniversidaddeValencia,Spain
Jorge Cancela F.Hoffmann-La RocheAG,Switzerland
KerstinDenecke BernUniversity ofAppliedSciences, Switzerland
PaulR.DeMuro Royal PalmCompanies,USA
MacarenaEspinoza UniversidaddeValencia, Spain
Faisal Farooq Qatar Computing ResearchInstitute, Qatar
Elia Gabarron Norwegian Centre for E-health Research, University Hospital of North
Norway,Norway
JuanMGarcia-Gomez UniversidadPolitécnicadeValencia,Spain
MowafaHouseh HamadBinKhalifa University,Qatar
Minna Isomursu University ofOulu, Finland
Raghvendra Mall Qatar Computing ResearchInstitute, Qatar
FranciscoMonteiro-Guerra University CollegeDublin, Ireland
FranciscoJ.Núñez-Benjumea SalumediaLabs,Spain
Sofia Ouhbi UnitedArabEmirates University,UnitedArabsEmirates
JosoaPalotti QatarComputing Research Institute, Qatar
ChrisPaton University ofOxford,UK
Vicente Traver UniversidadPolitécnica deValencia,Spain
Nabil Zary Mohammed Bin Rashid University of Medicine and Health Sciences
(MBRU),UnitedArab Emirates
xiii
Preface
The use of mobile and wearable devices for medical and wellness appli-
cations is becoming increasingly common nowadays. There are thousands
of applications for promoting physical activity, helping patients who are
living with chronic diseases such as diabetes and cancer. Furthermore,
healthcare professionals have in their phones access to various clinical tools.
Despite all the possibilities, the design, development, validation, and
scale-up of mHealth solutions are not trivial tasks. Many technical chal-
lenges remain; furthermore, usability and user engagement also present
complex aspects that can cause great innovations to fail. As mHealth so-
lutions are to be integrated into a diverse and complex societal context,
special consideration needs to be given to ethical, legal, and cybersecurity
aspects. This book aims to become a reference for stakeholders thinking
about using or developing mobile and wearable solutions in the health
domain. The book is designed for a multidisciplinary audience.
This book provides a toolbox for healthcare stakeholders involved in
decision-making regarding thedesign, development,andimplementation of
mHealthsolutions.Newcomerstothefieldfrombotharesearchandpractice
point of view can gain from this book an overview of the most important
aspects of mHealth. This book provides study cases, key references, and
insightsfromthepersonalexperienceoftheauthors.
xv
CHAPTER 1
Introduction to digital health
approach and mHealth
applications for participatory
health
Mohy Uddin, MD1, Shabbir Syed-Abdul, MD, MSc, PhD2
1ExecutiveOffice,KingAbdullahInternationalMedicalResearchCenter,KingSaudbinAbdulaziz
UniversityforHealthSciences,MinistryofNationalGuard-HealthAffairs,Riyadh,KingdomofSaudi
Arabia;2GraduateInstituteofBiomedicalInformatics,TaipeiMedicalUniversity,Taipei,Taiwan
Contents
References 5
Due to the rising demands and pressing needs of global health, the
healthcare industry has gone through constant flux and transformed over
the time. From the inception of modern medicine in 18th century,
healthcare has become dependent on technologies due to the periodic
requirements; and in the beginning of 21st century, the integration of
information and communication technologies (ICTs) in healthcare infra-
structure became a sine qua non [1]. Looking back in 1990s, ICTs
continued to accelerate from personal computers to eHealth, telemedicine,
medicine2.0,andhealth2.0;andlaterin2010s,thedisruptivetechnologies
came into sight to make an impact [1]. Rapid growth of medical knowl-
edge, needs of informed decision-making, unavailability of informatics
tools, increasing cost of healthcare, lack of medical manpower, financial
unsustainability of healthcare systems, patient empowerment and democ-
ratization of care were some of the driving forces that reflected the
imminent needs of healthcare paradigm shift, and implied to look into
digital technologies and disruptive innovations in healthcare [2]. Digital
health,ingeneral,canbedefinedas“aculturaltransformationoftraditional
healthcare” [2] and “use of information and communications technologies
to improve human health, healthcare services, and wellness for individuals
and across populations” [3]. By reforming and modernizing the healthcare
servicesandsystemsintherecentdecade,digitalhealthhasbecomepartand
DigitalHealth
ISBN978-0-12-820077-3 ©2021ElsevierInc.
1
https://doi.org/10.1016/B978-0-12-820077-3.00001-8 Allrightsreserved.
2 DigitalHealth
parcel of the current healthcare practices and is considered as the corner-
stone of the participatory / personalized health. With the advent of
smartphones and sensing technologies, the concept of mobile health /
mHealth / connected health emerged as another influential and promising
name in digital health technologies. mHealth, which exploits mobile and
wearable technology applications to support health, has played a pivotal
roleinfacilitatingthehealthcareprofessionalsininformedclinicaldecision-
makingbyprovidingtheinformationaccessatthepointofcare,connecting
the healthcare stakeholders especially healthcare professionals and patients,
management of health-related behaviors, early detection of diseases and
remote patient monitoring [4e7]. The emergence of mobile, participatory
and personalized sensing along with the health-related data capture has
added another dimension for healthcare data aggregation and analysis [8,9].
mHealth not only holds the promise of healthcare transformation for
individual patients but also has great prospects for population health and
epidemiology as well [8,10]. Disruptive technologies, such as artificial
intelligence (AI) applications in data mining and analytics using mobile and
wearable devices, have opened new avenues in the field of digital health.
The term of participatory health, boosted in early 2000s, presents a para-
digmshifttoimprovethequalityofpatients’healthbyinvolvinghealthcare
professionals and patients as the key partners; and is based on the constit-
uents of digital health mentioned above, such as patient engagement and
empowerment, patient-centered care and shared decision-making
[4,11e13]. This shift emphasizes on the patients’ well-being and wellness
as the central focus by empowering the patients the opportunity to
participateinshareddecision-makingbasedontheirvaluesandpreferences,
and ultimately bringing the positive care and healthy lifestyle for them. So,
in this context, the digital health platforms, providing the required tech-
nologies and tools, are crucial for enabling patients’ partnership and
collaboration with the care providers to drive and support participatory
health [4,14,15].
This book covers the theoretical aspects of digital health like method-
ologies, models, policies, regulations, opportunities and challenges in cur-
renthealthcarepracticesfirst;andthenreportsthepracticalaspectsofdigital
health approach using use cases, implementation, evaluation and sustain-
abilityofvariousmobileapplicationsandwearablesystemsinthehealthcare
industry that can lead to participatory / personalized health for tomorrow’s
healthcare. In order to provide an overview of the book here, we will go
through brief summaries of all chapters one by one. The next chapter
IntroductiontodigitalhealthapproachandmHealthapplicationsforparticipatoryhealth 3
“Digital health in the era of personalized healthcare: opportunities and
challengesforbringingresearchandpatientcaretoanewlevel”byCancela
etal.,providesoverview,opportunitiesandpromisesofdigitalhealthinthe
context of personalized healthcare. Using examples of digital health
technologies and advanced analytics in clinical research and care delivery
pathways, it discusses various aspects through which healthcare can be
personalized, and looks at different challenges, such as adoption and
acceptance of digital health solutions. Moving forward towards the
adoption of digital health in the society, the next chapter “Digital health
regulatory and policy considerations” by Jarrin and Parakh, sheds light on
the role of government policies, laws and regulations related to the
implementation of digital health solutions. Using examples of various US
government health agencies, it explains the development, reimbursement
and adoption of digital health; and provides understanding of regulatory
considerationsfromthebeginning,i.e.novelideastothelaststages,suchas
evaluation and impact of digital health products sequentially. In order to
understandtheunderlyingmechanismofhealthbehavioranddesignhealth
interventions,thenextchapter“HowtousetheIntegrated-ChangeModel
to design digital health programs: pragmatic methodology” by Cheung
et al., first explains the sociocognitive theories and determinants related to
health behavior and outcomes, and then integrates and applies them using
an Integrated-Change Model (I-Change Model), which is based on three
phases: awareness, motivation and action for smoking cessation. It provides
detailsaboutthepragmaticmethodologytodesigntailoredhealthprograms
in the form of four broad steps that include: selection of theoretical model,
formulation of interventional goals and objectives, identification of salient
beliefs, and designing the contents and algorithms for the digital health
program. Based on the I-Change Model discussed in the previous chapter,
the next chapter “Using the Integrated-Change Model to design digital
healthprograms:thecaseofsmokingcessation”byCheungetal.,elaborates
the pragmatic methodology for designing tailored digital health program
using a case of smoking cessation by describing both qualitative as well as
quantitative evaluations and providing a graphical computer-tailored pro-
gram outline. Looking into new avenues of computer tailoring, it explores
the role of AI in comparing and analyzing the rule-based and data-driven
tailoring for health behavior change. Moving further toward technologies
and applications, the next chapter “Wearables, smartphones, and artificial