Kronik Hastaların Uzaktan İzlemine Yönelik Teletıp Platformu

Kronik hastalıklar küresel bazda artış göstermekte olup ancak etkili bir hastalık yönetimiyle kontrol altına alınabilmektedirler. Bu hastalıkların kontrolü için hastaların uzaktan izlenmesine olanak sağlayan teletıp sistemlerinin büyük fayda sağlama potansiyelleri vardır. Ancak bu sistemlerin ölçeklenebilirliğini ve sürdürebilirliğini sağlamak önem arz etmektedir. Bu çalışmada, kronik hastaların uzaktan takibini gerçekleştirebilmek için yeni bir teletıp platformu önerilmektedir. Bu platform hastalara sağlık verilerini sistem üstünden doğrudan ve kolaylıkla takiplerini yapan sağlık personeli ile paylaşabilme olanağı sunmaktadır. Sağlık personeli ise hastalık seyrindeki gelişmeleri ve tedavi hedeflerini bu veriler sayesinde uzaktan kontrol edebilmektedir. Ayrıca sağlık personeli platform üzerinden belirleyeceği hastaya özel sağlık verisi eşik değerleri ile kendisine ve/veya hastaya otomatik bildirim mesajı gönderebilmekte, böylelikle hasta verilerini sürekli manuel olarak incelemek yerine, platform üzerinden gelecek bildirimler vasıtasıyla hastaya gerektiği zaman ve vakit kaybetmeksizin müdahalede bulunabilmektedirler. Önerilen platform ile kronik hastalık yönetimi iyileştirilebileceği gibi sağlık personeline olabildiğince az iş yükü getirilerek verilecek sağlık hizmetinde verim ve kalite artışının da sağlanmasıyla platformun sürdürülebilirliği de temin edilebilecektir. Çalışmada platformun ölçeklenebilirliği, eş zamanlı istek testleri ile analiz edilmiştir. Platform üstünden bildirim mesajı göndermenin, 500 eş zamanlı istek için düşük tepki süresi (~750 ms), yüksek verimlilik (saniyede ~250 istek) ve düşük hata oranı (%1.3) ile gerçekleştiği gözlenmiştir. Bu sonuçlar tasarlanan teletıp platformunun birçok kullanıcıdan gelen veri akışının üstesinden gelebileceğini ve platformun ölçeklenebilir olduğunu göstermektedir.

Anahtar Kelimeler:

Teletıp, Uzaktan Hastalık İzlem, Hastalık Yönetimi, Kronik Hastalıklar

Telemedicine Platform for Remote Monitoring of Chronic Patients

Chronic diseases are increasing globally and can only be controlled with effective disease management. Telemedicine systems allowing remote monitoring of patients have a potential to bring great benefit for controlling these diseases. However, it is important to ensure the scalability and sustainability of these systems. Here, a new telemedicine platform is presented for remote monitoring of chronic patients. This platform provides patients to share their health data directly and easily with the health care personnel, who can remotely control disease progress and treatment goals with the shared data. Furthermore, the personnel can send an automatic notification message to themselves or/and to the patient when a patient specific health data threshold value set through the platform is reached. Hence, the health care personnel can improve the disease management with timely interventions using the platform notifications, instead of analyzing the data constantly. With this platform, chronic disease management can be enhanced and the sustainability of the platform can be ensured by bringing as little workload as possible to the personnel while increasing the efficiency and quality of health service. In the study, the scalability of the platform was analyzed using concurrent request tests. It was observed that sending the notification message through the platform was handled with low response time (~ 750 ms), high throughput (~ 250 requests per second) and low error rate (1.3%) for 500 concurrent requests. These results show that the designed telemedicine platform can manage the data flow from many users and the platform can be scalable.

Keywords:

Telemedicine, Remote Disease Monitoring, Disease Management, Chronic Diseases,

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The World Health Organization Regional Office for Africa. 2017. http://www.afro.who.int/health-topics/noncommunicable-diseases (Erişim tarihi: 17.01.2019).
The World Health Organization. 2018. http://www.who.int/gho/ncd/mortality_morbidity/ncd_total/en/ (Erişim tarihi: 17.01.2019).
Rauniyar, M., Shrestha, J., Raj, L. B., Shrestha, A., Acharya, K. 2017. Disease Pattern, Morbidity Indicators in a Tertiary Care Center of a Developing Country, Annals of Public Health and Research, Cilt. 4, s. 1055.
Bane, A., Bayisa, T., Adamu, F., Abdissa, S. G. 2016. Medical Admissions and Outcomes at Saint Paul’s Hospital, Addis Ababa, Ethiopia: a retrospective study, Ethiopian Journal of Health Development, Cilt. 30, s. 50-56.
Hernandez, C., Jansa, M., Vidal, M., Nunez, M., Bertran, M. J., Garcia-Aymerich, J., Roca, J. 2009. The burden of chronic disorders on hospital admissions prompts the need for new modalities of care: a cross-sectional analysis in a tertiary hospital, QJM, Cilt. 102, s. 193-202. DOI: 10.1093/qjmed/hcn172
Bloom, D.E., Ca ero, E.T., Jané-Llopis, E., Abrahams-Gessel, S., Bloom, L.R., Fathima, S., Feigl, A.B., Gaziano, T., Mowa , M., Pandya, A., Prettner, K., Rosenberg, L., Seligman, B., Stein, A.Z., Weinstein, C. 2011. The global economic burden of noncommunicable diseases, World Economic Forum, Geneva, 46s.
Boutayeb, A. 2006. The double burden of communicable and non-communicable diseases in developing countries, Trans R Soc Trop Med Hyg, Cilt. 100, s. 191-199. DOI: 10.1016/j.trstmh.2005.07.021
The World Health Organization. 2018. http://www.who.int/en/news-room/fact-sheets/detail/noncommunicable-diseases (Erişim tarihi: 17.01.2019).
Rietzschel, E. R., De Buyzere, M. L. 2018. Hypertension: time for doctors to switch the driver's seat?, Lancet, Cilt. 391, s. 914-916. DOI: 10.1016/S0140-6736(18)30317-9
Kessel, K. A., Vogel, M. M., Kessel, C., Bier, H., Biedermann, T., Friess, H., Herschbach, P., von Eisenhart-Rothe, R., Meyer, B., Kiechle, M., Keller, U., Peschel, C., Schmid, R. M., Combs, S. E. 2017. Mobile Health in Oncology: A Patient Survey About App-Assisted Cancer Care, JMIR Mhealth Uhealth, Cilt. 5, s. e81. DOI: 10.2196/mhealth.7689
Strehle, E. M., Shabde, N. 2006. One hundred years of telemedicine: does this new technology have a place in paediatrics?, Arch Dis Child, Cilt. 91, s. 956-959. DOI: 10.1136/adc.2006.099622
Sood, S., Mbarika, V., Jugoo, S., Dookhy, R., Doarn, C. R., Prakash, N., Merrell, R. C. 2007. What is telemedicine? A collection of 104 peer-reviewed perspectives and theoretical underpinnings, Telemed J E Health, Cilt. 13, s. 573-590. DOI: 10.1089/tmj.2006.0073
Piette, J. D., Valverde, H., Marinec, N., Jantz, R., Kamis, K., de la Vega, C. L., Woolley, T., Pinto, B. 2014. Establishing an independent mobile health program for chronic disease self-management support in bolivia, Front Public Health, Cilt. 2, s. 95. DOI: 10.3389/fpubh.2014.00095
Azar, M., Gabbay, R. 2009. Web-based management of diabetes through glucose uploads: Has the time come for telemedicine?, Diabetes Research and Clinical Practice, Cilt. 83, s. 9-17. DOI: 10.1016/j.diabres.2008.09.055
Agarwal, R., Bills, J. E., Hecht, T. J., Light, R. P. 2011. Role of home blood pressure monitoring in overcoming therapeutic inertia and improving hypertension control: a systematic review and meta-analysis, Hypertension, Cilt. 57, s. 29-38. DOI: 10.1161/HYPERTENSIONAHA.110.160911
McManus, R. J., vd. 2018. Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): an unmasked randomised controlled trial, Lancet, Cilt. 391, s. 949-959. DOI: 10.1016/S0140-6736(18)30309-X
Friedman, R. H., Kazis, L. E., Jette, A., Smith, M. B., Stollerman, J., Torgerson, J., Carey, K. 1996. A telecommunications system for monitoring and counseling patients with hypertension. Impact on medication adherence and blood pressure control, Am J Hypertens, Cilt. 9, s. 285-292. DOI: 10.1016/0895-7061(95)00353-3
Piette, J. D., Datwani, H., Gaudioso, S., Foster, S. M., Westphal, J., Perry, W., Rodríguez-Saldaña, J., Mendoza-Avelares, M. O., Marinec, N. 2012. Hypertension Management Using Mobile Technology and Home Blood Pressure Monitoring: Results of a Randomized Trial in Two Low/Middle-Income Countries, Telemedicine and e-Health, Cilt. 18, s. 613-620. DOI: 10.1089/tmj.2011.0271
Ferrante, D., Varini, S., Macchia, A., Soifer, S., Badra, R., Nul, D., Grancelli, H., Doval, H., Investigators, G. 2010. Long-term results after a telephone intervention in chronic heart failure: DIAL (Randomized Trial of Phone Intervention in Chronic Heart Failure) follow-up, J Am Coll Cardiol, Cilt. 56, s. 372-378. DOI: 10.1016/j.jacc.2010.03.049
Bellazzi, R., vd. 2002. A telemedicine support for diabetes management: the T-IDDM project, Comput Methods Programs Biomed, Cilt. 69, s. 147-161. DOI: 10.1016/S0169-2607(02)00038-X
Milani, R. V., Lavie, C. J., Bober, R. M., Milani, A. R., Ventura, H. O. 2017. Improving Hypertension Control and Patient Engagement Using Digital Tools, Am J Med, Cilt. 130, s. 14-20. DOI: 10.1016/j.amjmed.2016.07.029
Shoulders, B., Powell, L. 2019. Reaching for Goal: Incorporating the Latest Hypertension Guidelines Into Practice, The Journal for Nurse Practitioners, Cilt. 15, s. 102-109. DOI: 10.1016/j.nurpra.2018.09.011
Milani, R. V., Bober, R. M., Milani, A. R. 2017. Hypertension management in the digital era, Curr Opin Cardiol, Cilt. 32, s. 373-380. DOI: 10.1097/HCO.0000000000000405
Bode, B. W. 2000. Clinical utility of the continuous glucose monitoring system, Diabetes Technol Ther, Cilt. 2, s. 35-41. DOI: 10.1089/15209150050214104
Ndlovu, K., Littman-Quinn, R., Park, E., Dikai, Z., Kovarik, C. L. 2014. Scaling up a Mobile Telemedicine Solution in Botswana: Keys to Sustainability, Front Public Health, Cilt. 2, s. 275. DOI: 10.3389/fpubh.2014.00275
Fromme, H. B., Chen, C. O., Fine, B. R., Gosdin, C., Shaughnessy, E. E. 2018. Pediatric Hospitalist Workload and Sustainability in University-Based Programs: Results from a National Interview-Based Survey, J Hosp Med, Cilt. 13, s. 702-705. DOI: 10.12788/jhm.2977
Trent, S., Tatsubori, M., Suzumura, T., Tozawa, A., Onodera, T. 2008. Performance Comparison of PHP and JSP as Server-Side Scripting Languages, s. 164-182. Issarny, V., Schantz, R., ed. 2008. Middleware 2008, Springer, Berlin, Heidelberg, 428s. DOI: 10.1007/978-3-540-89856-6_9
Hu, X., Wang, L., Sheng, Z., TalebiFard, P., Zhou, L., Liu, J., Leung, V. C. M. 2014. Towards a service centric contextualized vehicular cloud. The fourth ACM international symposium on development and analysis of intelligent vehicular networks and applications, 21-26 Eylül, Montreal, Kanada, s. 73-80. DOI: 10.1145/2656346.2656351