Associated Pilot "NCSR" in Greece

Motivation for the Proposal

Following the successful development of many EU funded projects like Intermed, USEFIL, TilleIpokratis, Profound and others, innovative AAL technologies, services and applications have been developed by NCSR “Demokritos”. Many Municipalities, prefectures and areas in the territory of Greece have expressed their interest and intention for using to exploit these developed ALL technologies as well as other multi-vendor low cost services for the benefit of the local inhabitants.

The above governmental entities are in close contact with the consortium partners (Euroaction SA , NCSR “Demokritos” and Syndesis Ltd) to become their local coordinator and identify those open-source low-cost AAL services that will permit them to offer high quality AAL services improving home care for elderly but with minimum cost.

More specifically, the goal of the public bodies (municipalities and prefectures) from this proposal is to further make use of advanced ICT open-source technologies avoiding at the same time one-vendor solutions to facilitate the use and expansion of the social and health care services for active and independent Living at lower costs.

NCSR “D” and its spinoff company ‘Syndesis Ltd’ are aiming through this proposal to integrate their AAL technologies with the ReAAL ecosystem and extend their own services with more open source modules and apps. More specifically, NCSR interest in Piloting within ReAAL project concerns:

  • Integrate its own AAL services with the open AAL middleware universAAL compliant as competence advantage
  • Exploit universAAL to extend its own AAL applications with new features
  • Experiment with service composition through common universAAL middleware

Euroaction S.A. from the other side, exploiting its communication link with many municipalities, will be responsible for the contact with the municipalities as to set up the pilots, evaluate & validate the results and promote the activities as well as the achieved results. Of course becoming a member of the Pilot concept is something that will help these entities to extend their expertise and know-how.

Piloting Concept

RemindMe App (Adherence to Medical Plans Application)

The RemindMe App aims to provide efficient and effective means of increased adherence to medical recommendations and treatments for elderly persons. Its target (end-) users are people living at home and in need of assistance/care (elderly, chronic patients etc.) The RemindMe App provides the following services;

  • Tracks remaining quantity, time to refill, dose history, and adherence history with password protection (records timing and dosing for medications and medical plans and supplements) and shares information with doctors and pharmacy
  • Offers visual and audio reminder and refill alerts (alerts are triggered one time only, not continuously), including notifications
  • Synchronizes information with a “reminder pillbox”
  • Offers dynamic scheduling from the doctor with maximum or minimum daily doses
  • Requires registration at a specific site from the doctors for use
  • Locates nearby pharmacies
  • Shows daily medication list that can be checked off throughout the day
  • Available in English and Greek
  • Accesible from mobile devices

The RemindMe app is being accessed through mobile devices, such as tablets and provides patients medication reminder service via a user friendly User Interface.

UI for the RemindME App

It is a known fact that there is inappropriate medication use among elderly home care patients in Europe, risk factors are poor economic situation, polypharmacy, depression, high age and living alone. Incorrect use of medications leads the elderly even more to cause forgetfulness and confusion and are major sources of unintentional medication non adherence.

The application is running on any web connected device and inform the end users about their planned medications or any other activities as requested and prescribed by their doctors and care personnel. The registration of the events is being conducted by the care-givers (formal and informal) whereby the medical personnel and services can monitor the adherence behaviour of the elderly people. The architecture of the system, as shown below, consists of a Calendar Server, the XMPP Server, the four Databases as well as the Web Services and the applications. Special care was given to design the suitable application’s interface. It concerns a user friendly interface which makes the operation easy, efficient, and enjoyable especially for elderly people.

The RemindMe application that will be integrated with ReAAL modules and will be validated within the proposed pilot is using a web based platform and is being hosted in NCSR “D” premises. The web services and the relevant API which is open to external developers allow the integration with the universAAL middleware and relevant ReAAL services. The specific application and the related monitoring protocols are under the guidance of the A1 EIP on AHA strand.

Health-Tracker App

New technology is transforming mobile devices into portable vital-sign monitors capable of detecting dangerous health conditions, like irregular heart rhythms and others. The Health-Tracker app:

  • Monitors health status (such as vital signs like respiration rate, heart rate and rhythm, and their blood oxygen saturation, Blood pressure and weight) and progress on health goals using the health-tracker of vital signs

  • Enables users to view, download and share with their doctors and carers personal health data

  • Provides analysis of the monitoring data providing a Health Risk Assessment

  • Requires registration at a specific site from the doctors for use

  • Enables doctors to send predefined questionnaires to the registered users following the monitoring data

  • Available in English and Greek

  • Accessible from mobile devices

The sensors include medical CE devices as listed below:

  • A&D Blood Pressure UA767PBT-Ci

  • A&D Weight Scale UC355PBT-Ci

  • Onyx II Oximeter

The Health-Tracker app provides a holistic view of a user’s health empowering patients to interact with physicians and actively participate in their care.

Health-Tracker App monitoring data interface

The application allows the professionals to contact the end users by sending pre-defined questionnaires. Since not everything can be measured by sensors, it is necessary to combine objective measurements with subjective self-observations. In such a case, the sample questionnaire, as part of the Health-Tracker app, will cover this feature.

Sample questionnaire

Deployment Plan

1. “universAALise the proposed applications of the RemindMe and the Health-Tracker applicaitons. February 2015 – April 2015.

Within the realm of the project we will adapt our application into the universAAL framework and upload the apps in the uStore. Both applications will be Universaal compatible, implementing Universaal Ontology for intercommunication. The RemindMe will use the Context Bus to register context event patterns for the Health-Tracker application to subscribe to. These patterns will trigger functionalities depending on the type of medication, the patient’s medical history and the last reported health measurements. All messages (medication reminders, medication prescriptions, etc.) will pass through the platform to the relative Context Publisher, which will translate their content to the relative ontologies and register them into the Context Bus as Context Events. The Context History Entrepot (CHE) will receive and store the data and then, the Situation Reasoner can query the CHE and proceed with publishing Context Events or service requests without human intervention. The Health-Tracker application will have similar procedures, using universAAL’s Context History Entrepot, Ontologies and Situation Reasoner. We will integrate our applications with other applications available in Universaal projects, in order to provide a wider range of functionalities that are interoperable. We will also try to work and try to integrate the uAAL android PAD apps, and uAAL android STB (set top box) TV services. We believe that these modules will complement our AAL services. In order to take advantage of the Android version of the uAAL middleware to enrich Health-Tracker App, the “universAAL for Android” will be used, which ports the universAAL middleware directly to Android.

A web based platform that already is running in NCSRs’ premises allow the different entities (elderly people, professionals, social carers) to be able to get registered in the platform through the same interface. This registration will allow the RemindMe and the Health-Tracker apps to communicate with the data base and send the monitoring data. The RemindMe and the Health-Tracker apps will be downloaded via the uStore by the patients/elderly to their PC/mobile device. All the other stakeholders such as family members, doctors, unofficial carers, friends etc will have access to the monitoring data through a web based interface.

One Login – Different web interfaces for Professionals, unofficial carers, end users

It has to be mentioned that the two REAAL applications that will be universaalised will concern the end users (patients/elderly) and will allow them with an ease of use way to monitor their behaviour and access some basic information. Also a real-time access and communication mean will be available between the involved physicians and formal professionals, the patients/elderly people (regarding their health data and other assisting living services), their direct family members and unofficial social carers belonging to this elderly persons; who will have access to selected monitoring information through the web interface

The integration of the RemindMe App with the universAAL platform would enable additional functionalities regarding medical treatment adherence, such as triggering alerts to the treating doctor, nurse or a relative, when the patient has not confirmed the dosage intake within a predefined time period despite the reminding alarms. These triggering events can be sent to other sensors within the house through the universAAL context bus. Likewise, the Health-Tracker App would be enriched by integration with the universAAL platform as automatic events could be sent to external users or sensors when an off-the-limits measurement is recorded, thus enabling timely response, revision of the treatment plan, change of pills or dosage, etc.

2. Going through ReAAL “lab tests” for about two months: May 2015- June 2015

3. Doing our own “site tests” (real-life but controlled test in the pilot site with few voluntary end users) to make sure that everything is prepared well for the roll-out of the universAALized application in real life. RemindMe application with 2 users for each pilot site and Health Tracker application with 2 users for each pilot site.These tests will run within July 2015-August 2015

4. Deployment operation: one or more iterations of expansions to the whole set of planned users, including the subtasks for installation, configuration / customization of RemindMe and Health Tracker application, training and user mentoring, and on-site support : September 2015 until January 2016

5. Performing the evaluation activities defined by ReAAL parallel to all the above activities.

User Planning

The involved users of the pilot will be 30 elderly people (above 65 years old, low income) and more than 60 involved stakeholders (social Workers / Nurses/doctors and family care-givers). The total number of the end users and the involved stakeholders will be identified by the municipalities and their involved services called “Assistance-at-home” and the Open Protection Centers for the Elderly (“K.A.P.I”). The group of elderly persons will be recorded and analysed not only for metrics such as income (under 300 € a month), age, demographics, ability to use simple ICT device, cognitive status & willingness to participate but also depending on what they are suffering from (diabetes, blood-pressure, kidney failure and so on). Together with the professionals from the ‘Assistence-at-home- service and the K.A.P.I.’s , which includes also general practitioners, will be assessed for which group of people (focus group) the RemindMe and Health-Tracker applications are most suitable with keeping in mind to improve as much as possible the independence and self-supportiveness of this elderly person. On one hand the elderly persons are supported by formal care-givers as the “Assistance-at-home” services and the K.A.P.I. centers but on the other hand there are also the informal care-givers as direct family members and volunteers. Therefore, the amount that releases the secondary stakeholder (direct family member, volunteer and so on) from duties by the involvement of the application-usage will also play an important role.

Deployment

Euroaction S.A. will start deployment from July 2015. The period before will be used very intensively as the whole deployment has to be built up from scratch in a structural way. The pilot sites and their end-users are not yet familiar with ‘informed consent’, ‘ethical committee’, their legal rights, quality of life issues and so on. A methodical approach will be used in order to use the achieved results and to create a platform for future further development on a broader scale.

Value Proposition

It is expected that the RemindMe” and “Health-Tracker” will support the elderly to such an extent that they will be able to live longer independently at home. Furthermore, it means that the everyday life for elderly becomes more comfortable as they will be proud on what they still achieve, enjoying at the same time life fully. On the other hand, it will lead to a decrease of public expenditure as people are able to stay longer at home avoiding in this way expensive hospital admission. The proposed application promotes “ageing well” and “prevention” concepts, implementing innovative web based ICT solutions and providing services more adaptable to elderly needs and preferences leading to a better quality of elderly care.

Value Chain – Stakeholders

In the value chain of the RemindMe and Health-Tracker applications are involved official (doctors and others) and unofficial care-givers (family members, friends). In this pilot the personnel from inter-municipality level “Assistance-at-home” services and Open Protection Centers for the Elderly (“K.A.P.I”) will be involved. These entities will provide the support service to the end users. The beneficiary and family can use the same web based platform and download form the uStore the relevant applications to exploit all the services. The caregivers on one hand will experience relief and increasing peace of mind while remotely monitoring. On the other hand the local authorities and health insurers are provided with efficient and low cost solutions maintaining at the same time a certain level of care.

The National Centre for Scientific Research (NCSR) "Demokritos"

NCSR “D” is a self-governing research organisation, under the supervision of the Greek Government and is the largest research centre in applied sciences and engineering in Greece. NCSR will participate in this pilot project with DAT and IIT having the role of the technology provider and providing its own infrastructures. NCSR-DAT has successfully taken part in several European and national e-health, AAL and e-learning projects. Within the realm of these projects e-health and e-learning platforms have been developed and hosted within NCSR/DAT premises as well as infrastructures, hospitals, end users has been established covering the broader area of Europe. The core business and skills of the Institute of Informatics and Telecommunications (IIT) include location based services, semantic information extraction from multimedia content for enhancement of ontologies, security of network, and wireless communication system (including quality acceptance), intelligent Networks and open architectures including protocol engineering. NCSR is participating in many EU funded projects that concern ageing and health technologies coordinating among the others the www.usefil.eu FP7 project.

Syndesis Ltd

Syndesis is a Spin off company of NCSR “D” which exploits advanced low cost technologies for collecting and analyzing data and vital signs, uses artificial intelligence and knowledge management techniques to develop decision support intelligent systems, design smart assistive living environments and uses WEB2.0 technologies to collect and distribute information. Syndesis is active in the B2C and in the B2B market by providing customised services by consulting and technically supporting other companies such as private hospitals to become “Virtual ehealth Operators” and insurance companies to develop e-health oriented products. Syndesis together with Euroaction S.A have implemented an ICT platform which is hosted in NCSR’s premises and is able to support ehealth and assistive living in a territory which consists of 59 municipalities all over Greece. Syndesis Ltd, will be the technology integrator of the universaalised apps and will support the operation of the pilots.

EUROACTION S.A

Euroaction A.E. is a consulting company, founded in 2007, which provides services and products towards local authorities, local organisations, wider bodies of the public sector and businesses active in the private sector. Starting from the principal of Total Quality Management and keeping these strict guidelines in account, the innovative thought and the everyday changing reality are conscious stratigical company’s choices for the long-term strategic planning objectives resulting in immediate solutions and mainly the prevention of future problems and obstructions. Euroaction A.E. has a succesfull trackrecord of collaboration with a wide range of local authorities, public bodies and private companies whereby the satisfaction of the customer is the main priority. The main sectors of action include the development of priorities of ESPA 2007 - 2013, the finding of financing for the public and private sector, the development of studies on the protection of environment, the support of social activity of Local Authority, activities of programs of health and technologies for health, development and promotion of particularities of each region, support in processes of implementation, operation and further development of work and studies, the aid in the rationalization and regularization of processes, supplies on the public sector, as well as the legal support of institutions and operations of the municipal self-government. Having participated with succes in projects related to social health and innovation, it opts to get even more involved within this field. Euroaction will support the whole partnership with the management and administrative activities and will also head the evaluation phase of the REAAL services.