by Lucia Perez Diego -

Gamification for elderly patients

Gamification in healthcare refers to the use of game-like elements, such as points, rewards, and competition, to engage patients and encourage healthy behaviours. This approach has become increasingly popular in recent years, as healthcare providers look for new and innovative ways to improve patient outcomes and satisfaction. Some of the ways that gamification is being used in healthcare today.

  1. Patient engagement: Gamification can be a fun and effective way to engage patients in their own care. By using points, rewards, and competition, patients are motivated to become more involved in their health and wellness and are more likely to stick to their treatment plans.
  2. Adherence to treatment: Gamification can help improve adherence to treatment, as patients are incentivized to take their medications and attend appointments. For example, patients can earn points for taking their medications on time and can compete with other patients to see who is most compliant with their treatment plan.
  3. Health tracking: Gamification can also be used to encourage patients to track their health and wellness metrics, such as weight, blood pressure, and physical activity levels. By using a point system, patients are motivated to improve their health and are rewarded for reaching their goals.
  4. Chronic disease management: Gamification can be particularly effective in the management of chronic diseases, such as diabetes, heart disease, and asthma. By using games and other game-like elements, patients are encouraged to take an active role in their care and are more likely to adhere to their treatment plans.
  5. Mental health: Gamification is also being used in the treatment of mental health conditions, such as anxiety and depression. For example, patients can use gamified apps to track their moods, complete therapy assignments, and earn rewards for meeting their goals.

In conclusion, gamification in healthcare is a growing trend that has shown promising results. By incorporating game-like elements into patient care, healthcare providers can create a more enjoyable and engaging experience for patients, which can lead to better outcomes and higher levels of satisfaction and overall health status.

>>> But how can all be applied when we talk about the elderly population?

Gamification can be an effective tool for engaging and motivating elderly patients as well. As older adults face a unique set of challenges related to their health and wellness, gamification can help to make their healthcare experience more enjoyable and effective. How gamification can be applied to improve the health and well-being of elderly patients.

  1. Encouraging physical activity: Physical activity is crucial for maintaining good health and independence as we age. Gamification can be used to encourage older adults to be more active by making exercise and physical activity more fun and engaging.
  2. Medication management: Many older adults take multiple medications, which can be difficult to manage and can lead to non-adherence. Gamification can be used to help older adults remember to take their medications and stay on track with their treatment plans.
  3. Cognitive stimulation: As we age, it’s important to maintain cognitive function and prevent decline. Gamification can be used to encourage older adults to engage in activities that stimulate their minds, such as crosswords, word games, and other brain games. These activities can be made more engaging by using gamification elements, such as points and rewards, to encourage patients to participate.
  4. Social engagement: Social isolation is a major problem for many older adults, and it can have a significant impact on their health and well-being. Gamification can be used to encourage social engagement and build a sense of community among older adults.

Gamification can be a valuable tool for improving the health and well-being of older adults. By using game-like elements, healthcare providers can make the healthcare experience more enjoyable and effective for older patients, improve patient outcomes and enhance the overall quality of life for older adults.

_ Literature:

  • K. White, Becky et al: Gamification and older adults: Opportunities for gamification to support health promotion initiatives for older adults in the context of COVID-19. In The Lancet Regional Health – Western Pacific (2022), https://doi.org/10.1016/j.lanwpc.2022.100528
  • de Vette, Frederiek et al: Engaging Elderly People in Telemedicine Through Gamification. In JMIR Publications – Advanced Digital Health and Open Science 3, no 2 (2015), DOI:10.2196/games.4561
by Lucia Perez Diego -

The psychological struggle of undergoing medical procedures.

Medical procedures can often have a profound impact on a person’s mental and emotional well-being. While physical side effects are usually the primary focus of discussion, the psychological side effects of medical procedures should not be overlooked.

Anxiety and stress are common feelings experienced before, during, and after a medical procedure. This can be especially true if the procedure is invasive or has a high degree of risk. Patients may worry about the outcome of the procedure, the pain it may cause, or the impact it will have on their daily life. This anxiety can cause physical symptoms such as increased heart rate, sweating, and difficulty breathing.

Depression can also be a side effect of medical procedures. This is especially true for procedures that have long recovery times, such as surgeries, or those that cause significant changes to a person’s appearance, such as plastic surgery. Patients may feel sad, hopeless, or have a loss of interest in their usual activities. Patients may struggle with accepting the changes to their bodies and may feel self-conscious or embarrassed.

It is important to remember that everyone reacts differently to medical procedures and that these side effects can vary in intensity and duration but it’s pretty safe to assess that medical procedures can have a significant impact on a person’s mental and emotional well-being and it is important to be aware of the potential psychological side effects.

Therefore, addressing patient anxiety before ongoing medical procedures is an important part of the medical professional’s role. By using a combination of communication, good communication is key to reducing anxiety in patients. Medical professionals should take the time to clearly explain the procedure, what it entails, and what to expect before, during, and after. They should also provide answers to any questions the patient may have, as well as address any concerns or worries the patient may have; empathy, patients are more likely to feel at ease if they feel understood and cared for by their medical professional. This, along with good listening skills, can help to establish trust and make the patient feel more comfortable; information, providing clear and concise information about the procedure, including the risks and benefits, can help patients feel more informed and in control. Patients should also be provided with information about what to expect during and after the procedure, such as pain management and recovery time, relaxation techniques, encouraging patients to practice relaxation techniques, such as deep breathing, visualization, or guided imagery, can help to reduce anxiety and promote calmness before the procedure; distraction techniques, reassurance, reassuring patients that the procedure is safe and that the medical team is experienced and well-equipped to handle any potential complications can help to reduce anxiety; and alternative treatments, medical professionals can help to reduce anxiety and promote a positive experience for patients.

In recent years, technology has made great strides in this topic. Digital tools have been developed to provide patients with accurate information, distraction, and relaxation techniques, all from the comfort of their own homes. Here are some of the most commonly used digital tools for reducing patient anxiety before ongoing medical procedures. Among them we can find:

  1. Patient education apps: These apps provide patients with detailed information about their upcoming procedure, including what to expect, how to prepare, and what to do after. They may also provide animations, videos, and illustrations to help patients better understand the procedure.
  2. Virtual reality tools: VR tools allow patients to experience a simulated version of the procedure in a safe and controlled environment. This can help to reduce anxiety by allowing patients to familiarize themselves with the procedure and understand what to expect.
  3. Relaxation and mindfulness apps: These apps provide guided meditations, deep breathing exercises, and other techniques to help patients relax and reduce anxiety. They can be used before, during, and after the procedure to promote a sense of calm.
  4. Distraction games: Simple games and puzzles can be a helpful distraction for patients who are feeling anxious before a procedure. These games can help take their mind off the procedure and promote a sense of calm.
  5. Telemedicine: Telemedicine allows patients to connect with their medical team from the comfort of their own homes. This can be especially helpful for patients who are feeling anxious about their procedure, as they can receive the support and reassurance they need from their medical team in a familiar and comfortable environment.

The anxiety and stress provoked by an upcoming medical procedure shouldn’t be overlooked because it impacts directly not only the patient’s well-being but also the efficiency of the medical procedure itself and the workload for the professional physicians. If a procedure has to be repeated because the patient was extremely shocked the first time, that means there will be extra costs and extra work for the physicians, creating a problem for all the parts involved.

In my opinion, the elderly population is still a hard rock for all the developments in this regard. They are a big part of our society, we keep increasing numbers of the population from 70 years old onwards and they are not as used to digital tools as younger people are. We can’t rely only on digitalisation to overcome all the struggles that come from this situation so we need to find either an analogue and effective solution or find a way to approach digital resources to this target group in an easy, soft and very friendly way specifically designed for them.

_Literature:

  • Rahman, Asmaa/Mahdy, Naglaa/Kamaly, Aiman: Predictive Factors Affecting Postoperative Quality of Recovery for Patients Undergoing Surgery. In IOSR Journal of Nursing and Health Science (IOSR-JNHS) 6, no 3 (2017), p. 50 – 60, 10.9790/1959-0603085060
  • De Rosis, Sabina/Barsanti, Sara: Patient satisfaction, e-health and the evolution of the patient–general practitioner relationship: Evidence from an Italian survey. In Health Policy 120, no 11(2016), p. 1279 – 1292, https://doi.org/10.1016/j.healthpol.2016.09.012
  • Elliot, Tania et al.: Beyond Convenience: Patients’ Perceptions of Physician Interactional Skills and Compassion via Telemedicine. InMayoClinic Proceedings: Patient’s perception, quality & outcomes 4, no3(2020), p. 305 – 314, https://doi.org/10.1016/j.mayocpiqo.2020.04.009
by Lucia Perez Diego -

Evaluation of Master Thesis

Technology as bridge between health professionals and patients.

Author: Julia Neunteufel
University: Paris Lodron Universität Slazburg

_______________________________________________________________________________________

Level of design

The design is a bit basic and poor. It looks like a very technological and scientific thesis but the author didn’t take the opportunity to play with design options. Once said that the overall structure of the content is very clear and clean, which makes the thesis perfectly readable and manageable.

Degree of innovation

The thesis seems to dig very deep into innovative procedures related to a human-centered approach to treating the topic of eHealth and mHealth. She mentions also design thinking processes that aren’t usually connected to the eHealth topics when approached by the scientific community. I think she really tries to link the coldest side of medical and technological topics and human psychology. Therefore I think this work might not be innovative when choosing the processes to go through but it is innovative in the way she connects human behaviour and emotions to a very well-known scientific topic.

Independence

The author uses many resources which help her by providing valuable information but she is the only one involved in the development of the master thesis. – Of course, supervised by her tutor. I think she makes a very good design process on her own, using different tools to reach her final goal.

Outline and structure

As I already mentioned in the design section, the master’s thesis is an extensive work structured in different parts in a clean and clear way. It is very easy to find specific parts or chapters thanks to its good organization in the index and she structures it in a very organic way according to the design process, helping the reader from the beginning to create a complete idea of what a research paper like this one entails.

Degree of communication

The author offers clear and fluent communication throughout the entire work. In some parts where the use of more technical words is required, she manages to make the content equally understandable and accessible to the reader, without avoiding the use of appropriate terminology.

In other sections, she uses a much more concise and shorter style, in a more schematic format, but which also helps to understand other types of material and always in an organic way. I think he knows how to adapt his writing style very well to the context he is developing at the time, and he manages to make this subject, which at times may not be very attractive, seem accessible and interesting to many types of audiences.

Scope of the work

The work focuses on how technology can serve as a link between patients and medical professionals. Under this title, she focuses on topics related to human behavior, technological tools commonly used in medical practices (focusing especially on cardiology), eHealth, and mHealth, as cutting-edge examples of technology designed already taking into account the human-centered approach.

Orthography and accuracy

She writes the work in English. As far as I’ve read, I haven’t found any major spelling mistakes. It is obvious that English it’s not her mother tongue because the vocabulary she uses tends to be simpler than other papers or works from authors whose mother tongue is English. It’s still very well written and there is also usage of specific terminology, giving the text a scientific accuracy about the topics she is dealing with.

Literature

She uses many references both from books and scientific papers on the various topics she deals with, as well as from web pages where statistics from previous medical and psychological studies over the years can be found, medical and psychology journals, and articles related to human-centered design and the development of the user experience in the medical field.

by Lucia Perez Diego -

Nerve Sensors in Inclusive Musical Performance

Methods and findings of a multi-day performance research lab that evaluated the efficacy of a novel nerve sensor in the context of a physically inclusive performance practice.

by Lloyd May and Peter Larsson

Making the musical performance more accessible is something that many artists, such as Atau Tanaka and Laetitia Sonami, as well as scientists, have been aiming for a while. Therefore many efforts go toward the “nerve-sensor” direction. With this kind of approach, the detection of signals from nerve fring is more likely to happen rather than the skeletal muscle movement, so performers with physical conditions have more control over the sensors.

Even though the variety of gestures wasn’t as broad as other gestural instruments offer, the affordance of communication of gestural effort was better as proved in the explorations made on different sound-practices like free improvisation and the development of a piece called Frustentions.

Thanks to the Electromyography, a technique used to measure the electrical activity of skeletal muscles and nerves through the use of non-invasive sensors placed directly on the skin, we have seen more and more people with muscle atrophy or compromised volitional control of skeletal muscles, having access to technologies, for example when it comes to gaming. But, as it usually happens, the broader the accessibility is the more potentially harmful lens can come with it. Therefore it is important to keep in mind that every individual is unique and be aware of the invisible boundaries that the technology can set around the people it’s supposed to serve.

The more people with different physical and mental abilities get involved in these sound-making explorations, the better and opener accessible the design of the interfaces will be.

For this specific exploration, there were 4 investigated parameters: sensor position, gesture types, minimal-movement gestures, as well as various sound-mapping parameters. The lab was structured into several sessions, each concluding with a performative exploration, as well as a structured public showcase and discussion at the end of the lab. Other research lines like minimal-movement “neural” gestures were also investigated but not much data could be gathered. The outcome of the session was the previous said composed piece: Frustentions. A fixed media composition developed during the workshop.

Three groups of gestures were determined during the sessions in order to record the needed data: Effort gestures, which were particularly suited to audio effects that are well-aligned to swelling such as distortion, delay, or reverb, and adjustment gestures, which often required full focus and were not necessarily accessible at all times during a performance; and trigger gestures.

The nerve sensor was compared with other interfaces like the MiMu glove, the Gestrument, and Soundbeam. Even though these other instruments allowed wider recognition of the number of gestures with better accuracy, it was more challenging to use with limited fine-motor capabilities. In addition, the wearable sensor afforded the performer greater opportunities to connect visually with ensemble members or the audience as there was no immediate requirement to view or interact directly with a screen.

Conclusions

Research aimed at making musical performance accessible to everyone is something that has multiple benefits, clearly on a physical level, but above all on a neural and psychological level. It is surprising how many things associated with leisure are out of reach for many people, simply because their physical condition does not meet the standards for which they are designed. The possibility that all these people can access activities of enjoyment represents a clear increase in the quality of life for them and for the people around them.

Nerve sensors are just one example, and thanks to this exploratory initiative we can get to know them and compare data with other instruments on the market. In more advanced stages of research, I would like to imagine that these interfaces are also used medically, to alleviate the effects of some diseases, improve physical conditions, and even reduce motor damage that originates in the brain by promoting nerve and muscle movement. Music is obviously a means of enjoyment, but together with science, it can be a means of healing.

by Lucia Perez Diego -

A good image worth more than a 1000 words 

Radiology is the discipline that is responsible for deciphering the information contained in images of our body to diagnose or inform other specialists and even the patients themselves of how the pathologies suffered are developing. 

Radiologists are exposed to a workload of approximately 200 cases in a normal working day. 200 cases equal 200 people, with different illnesses, and different stories. With this workload, the person’s story is normally relegated to the background, but we all know that human closeness in a context like this is a necessary asset and it should always remain in the foreground. 

There are different software tools, as well as imaging standards, that radiologists use to do their work. Among them, we could speak of DICOM (Digital Imaging and Communication in Medicine), the standard for the communication of information related to images. Regarding software, we could talk about PACSonWEB, a portal where both hospital specialists or doctors from private practice, and patients themselves can easily access their image repositories, avoiding the bureaucracy and long waits involved in transferring from one source to another. 

Companies from all over the world are dedicated to the development and improvement of these systems, trying to reduce as much as possible the time that specialists spend examining each image so that they can dedicate that time to their own professional well-being or to dealing directly with patients, procuring that necessary human proximity for a longer time. 

How can design help in this specific specialty? Through the interfaces and the constant study of the behavior of professionals in the work context. The interfaces with which doctors interact daily should be clear and accessible, all the most used tools should be quickly identifiable and above all, the series of images should be able to be combined in the way that is necessary to obtain a 360 view. degrees of the pathology being analyzed. It must be taken into account that these people spend the day in a dark room, therefore, the interfaces must be designed so as not to overexpose the eyes of the professionals. Likewise, it is at that very moment of image analysis in that dark room when the diagnosis is made, not afterward. Typing would be a waste of time, therefore the design and development of dictation tools and good speech recognition are highly necessary. 

To sum up, the continuous interaction with radiology professionals to understand their needs and how they work, the design and conception of interfaces in which navigation is totally intuitive, and the reinforcement of tools that facilitate voice interaction within the software, are the steps that the UX Design and UI Design must imminently address in order to improve the quality of life of radiologists in their work environment. 

________________________________________________________________________________________________________________

Literature:

https://www.dicomstandard.org/

https://adc.bmj.com/content/83/1/82

https://www.youtube.com/c/DrCellini

by Lucia Perez Diego -

Interview with a cardiologist (C) 

In the course of my visit to Spain during the Easter holidays, I had the opportunity to have a short interview with one of the heads of the cardiology department of the Salamanca general hospital.

After listening to what the doctor told me, 3 things were clear to me:

  • The time spent on correcting minor technical errors or sharing information between specialists should be reduced to the maximum in order to be able to use it in dealing directly with patients.
  • Advances in technology are very effective, but we cannot forget that the main customers of health systems are the elderly people, and this is going to be the tendency at least in the near future.
  • Pedagogy is key in order to making patients stop seeing the hospital as a hostile environment. Time and tools are needed to provide this inclusion prior to treatment and, if possible, the availability of real people for those who do not feel so comfortable with virtual assistants.

Here is the full interview.

*This interview has been the first instance recorded in Spanish and afterward translated and transcripted to this document. 

_________________________________________________________________

Me: Hello! Thank you for taking some time for me, I know you have probably a very packed day. 

C: Yes, indeed. But no problem at all, thank you for coming. 

Me: My pleasure. Just a little information before we jump into the interview itself: This interview is for educational use. I want my master’s thesis to be related to healthcare, more specifically speaking I want to find out what are the design challenges healthcare is facing right now. Since healthcare is just a big umbrella that brings together many different disciplines, I have decided to delve into radiology. I think it is a field where many different types of software and hardware are used, and also there is an ongoing relationship with other specialists and patients if I am not mistaken. All of this makes the field very attractive for a designer, and that’s why I’m here. 

The information will be shared in a blog that students and teachers from my department can access as well as will be used to shape the final version of my master thesis. Only if you consent, I’ll use some of the comments made during this session as quotes within the master thesis, only then, by using the proper form of citation. And here ends the bureaucracy. 

C: hahaha! No problem, of course, you can use the information for your master thesis and I’ll be happy to be quoted within it. So go ahead! 

Me: Thank you so much. Let’s start then. 

Me: How long have you been working here? 

C: 15 years already! 

Me: That is time enough to gather many different experiences. Tell me a bit about your daily routine. How many patients do you see on a normal day? 

C: 15 to 30. Depending on the pathologies. Sometimes I meet on the same day with patients who are going through similar pathologies because it is easier for me to do a bit of pedagogy with them and also to easily access the repositories. There is a huge archive where all heart diseases are collected, and they are labeled in alphabetical order by the name of the pathology. Therefore, I spend less time looking for a specific record if I move around the same area all the time. But of course, I always give priority to urgent issues, and you never know when a new one is going to show up during your day. 

Me: Besides meeting your patients, do you have other important meetings that you have to attend in your day? 

C: Other cardiologists. Residents. Specialists from many different fields, like, for example, radiologists. We compare diagnoses, we talk about further steps within a patient’s treatment… Nurses, and sometimes administrative staff. 

Me: Between all of those meetings, do you have time to take a break every now ad then? 

C: Hmmm… I guess I do have breaks, but not really as many as I’d need. Sometimes I don’t have time to eat properly or I can’t take the time to clear my mind after giving bad news to a patient. Although we are used to dealing with bad scenarios and informing patients about them, in the end we are all human beings, so it is also a human need to have a space to digest that you “hurt” someone’s feelings before going on with your day. 

Me: I understand. The breaks are not only to have a physical rest but also to recompose yourself psychologically. 

Me: Is there something you think that will make you have more of that time you are seeking? 

C: Hay muchas veces que las reuniones se podrían hacer más rápido. Algunos trámites administrativos podrían hacerse más rápido. La transferencia de datos de médico a médico para un diagnóstico posterior debería ser más rápida. Incluso hay ocasiones en las que tenemos que repetir procedimientos por falta de instrucciones dadas al paciente, o alguna pérdida de información. Son cosas que no deberían estar pasando en un gran hospital como este, porque si hay algo que buscamos, en realidad, todos buscan, es tiempo. 

Me: Let’s go to the analysis of some of the devices and procedures that you daily use. 

Me: What kind of devices do you use more often? 

C: Cardiac ablation catheters, Cardiovascular angioplasty devices, Cardiac pacemakers, Implantable cardioverter defibrillators, Prosthetic (artificial) heart valves, Stents, Ventricular assist devices, “domestic” monitor devices, web and mobile applications or portals. 

Me: Can we focus on the last ones? As I understand, patients can get more involved in those. 

C: Definitely. 

Me: Within the use of “domestic devices or those that patients take home, is the data collected sufficient to provide a complete diagnosis? 

C: Yes and no. For many patients, it is enough because we only look for abnormalities. So we see them or we don’t. But answering your question, no. It is not enough to completely diagnose a pathology. If we find an abnormality through the monitor, we will have to perform further procedures to find the best way to proceed with that specific patient. And many of those procedures will need to be done inside the hospital. 

Me: How many times do you need to repeat monitoring procedures? Average per year. 

C: Around 15% of the whole amount of procedures.  

Me: What do you think is the main cause? 

C: Technical problems many times. But there are also times when patients don’t understand exactly what we need for them, so we have to explain again how to interact with the device, what they can do, what they can’t do, and redo the procedure. 

Me: Is there a specific demographic group where the repetitions occur more often? 

C: Elderly people. In reality, most cardiology patients are older people. Sometimes we have children or young people who have heart problems but… You know, we are in a very old society. And it is expected to be even greater in the coming years… Medicine has to see the elderly as its main client and adapt procedures to them. And that takes time. Exactly what we don’t have here. 

Me: These elderly people, is there something they complain about when they are required to wear this device on them? 

C: They feel insecure. They don’t see why they need this machine if I’m here. I’m the doctor, what a machine is going to the better than me? They have a lot of questions. Many don’t even understand the most basic things so… They feel uncomfortable, even though they have to wear the device for only one or two days. 

Me: Do you think these people feel involved when dealing with these devices? Do they feel like an active part of the procedure or a secondary actor? 

C: Honestly, I think they feel totally aside. They don’t know what is going on. They follow instructions. Everything is cold and aseptic. They don’t have a voice. But they do have a voice, but many times we don’t have the time to listen to them because we use all our available time discovering what is going on there.  

Me: What do you think could be done in order to improve patient engagement and involvement?  

C: Definitely avoid all of those technical errors that are grabbing our time for the face-to-face relationship with our patients and the pedagogy we could do with them. More time = more pedagogy = less repetition of procedures = more rate of success when finding the diseases in their early stages. 

Me: What do you think has been already done to improve this? 

C: Many of our applications and portals, as well as AIs, provide training to our patients previous to their procedures. We go back to the problem of getting the elderly people there. They rather speak with you than navigate an application looking for the information they need or listen to the instructions from a non-human character. This has been widely discussed among the medical staff, so the awareness is also a good point and I guess some steps will be done to address this. 

Me: Thank you so much for your time. I think I have all I need. Do you maybe want to talk about something that I didn’t ask you that you would like to share with me? 

C: I think I don’t have any further information I can share with you. I already talked too much! But if more questions come up to your mind, don’t hesitate in contacting me. Thank you for the interview! 

by Lucia Perez Diego -

“A very long Wait”

#The Topic

“One month after my episode I finally got the device, I wore it for 2 days, and then I gave it back. My doctor called me 10 days after, I will have to go through the process again because she needed more data. So… almost two months will be passed by the time I get a diagnosis. It’s a very long wait”.

This is one comment I got from one of the patients I interviewed. The feeling of being involved in a process that takes a lot of time to give a result back creates a feeling of uncertainty in the patient while waiting for a diagnosis. This can lead either to anxiousness or tedium depending on the patient’s personality.


The old-school Holter devices method of data transmission relies on the patient returning the device, downloading the data to the hospital, and analyzing it by the doctor. In addition to time, the effectiveness of the collected data is questionable due to the fact that these devices record information for two days in which there may or may not be heart rhythm disturbances.

New devices are testing the use of advanced algorithms that allow data to be recorded 24/7, offering clear advantages when it comes to making a proper diagnosis. In addition to this, they allow the possibility of comparing with other data already recorded from patients with similar indications, which can facilitate the analysis process.

The use of this new technology is not yet fully widespread, but it is obvious that this is the way that must be taken to increase the speed of diagnosis, facilitate the doctors’ work, and care about the patient’s mental health. Maybe the use of this type of new generation holters, which can be easily used by patients at home, combined with specific and occasional medical tests (if necessary) carried out in the hospital by more complex devices that can record more interesting data, is the recipe that offers both better results and better user experiences. But, could domestic use devices reach the complexity of hospital devices without leaving aside their comfort of use for the patient? Probably, but when? Is it going to be a very long wait?

Pocket ECG Holter Monitor | New Generation of Holter Monitors

by Lucia Perez Diego -

Improving medical interfaces for patients

#The Topic

The Holter Monitor Interface is quite dated, bulky, and unintelligible. Patients do not feel involved in the process and do not understand what parameters are being measured.

In a world where technology users are more educated and informed than ever before, leaving patients out of the loop feels paternalizing. Making users feel disconnected from their own condition poses risk to their own health.

In the case of the Holter Heart Monitor, it is a much more advanced and capable device than the health wearables available in the market for consumers (e.g. Apple Watch, Miliband, Fitbit). But the interface in these wearables is more user-friendly and clear to inexperienced eyes.

Marrying the accuracy and depth of the data from the Medical Grade device with a tad of UX from the consumer–ready devices can help the patient understand what is going on in their body and be proactive towards a solution.

A better interface is the start of a change: From “patient”, by definition, waiting and passive, to an active player in their health status.

Garmin/Apple Watch/Fitbit

by Lucia Perez Diego -

Living with a Heart Rate Monitor

# The Topic

A heart rate monitor (HRM) is a personal monitoring device that measures heart rate in real-time or records the heart rate for later study. It is commonly used to collect heart rate data while performing various types of activity which are part of the patient’s day-to-day life. Portable medical devices are referred to as Holter Monitor which is designed for everyday use and does not use wires to connect.

Modern heart rate monitors commonly use one of two different methods to record heart signals: electrical and optical. Both types of signals can provide the same basic heart rate data, using fully automated algorithms to measure heart rate.

_ Electrical Devices: The electrical monitors consist of two elements: a monitor/transmitter, which is worn on a chest strap, and a receiver. When a heartbeat is detected a radio signal is transmitted, which the receiver uses to display/determine the current heart rate. This signal can be a simple radio pulse or a unique coded signal from the chest strap.

_ Optical Devices: More recent devices use optics to measure heart rate by shining light from an LED through the skin and measuring how it scatters off blood vessels. Smartwatches and cell phones can be included within this category, but their use for medical purposes is limited even though the accuracy in detecting several diseases increased significantly in recent years. Many professionals recommend anyway their use as support in data collection processes.

# Holter Monitor

A Holter monitor is a small, wearable device that keeps track of your heart rhythm. The doctor may want the patient to wear a Holter monitor for one to two days. During that time, the device records all heartbeats. This procedure can be repeated several times if the medical practitioner requires it to accomplish the goal of the overall study.

A Holter monitor test may be done if a traditional electrocardiogram (ECG) doesn’t deliver enough information about the heart’s condition. A Holter monitor may be able to spot occasionally abnormal heart rhythms that an ECG missed due to the short time that the patient is hooked up to the machine. The medical practitioner uses information captured on the Holter monitor to figure out if the patient has e a heart rhythm problem or a heart condition that increases your risk of an abnormal heart rhythm.

# What Patients say:

After interviewing two patients who had to wear the Holter monitor due to different heart conditions, plus the information collected in different clinical studies, these would be the most significant insights referring to the patient experience:

_ Most of the patients found the device uncomfortable. Sometimes, some of their daily activities were difficult to carry out due to the device.

_ Some patients had difficulty putting the device back on after showering. Due to this, the collected data wasn’t accurate.

_ Even though the majority of patients expressed full trust in their doctors, many did not feel involved in the process. They simply had to “follow orders” but did not understand what kind of data was being measured.

_ Some patients experienced a feeling of vulnerability when they gave the device back to their medical facility. Although the device was uncomfortable to wear, it made them feel safe, assuming that their heart was being controlled. Once they removed it, that feeling of security disappeared.

_ Some patients experienced skin allergies due to the adhesive tape on the device.

# What Doctors say:

After interviewing a cardiology physician and a general practitioner, I was able to gather the following insights:

_ It is difficult to ensure successful measurements with elderly patients due to the technical requirements of the device. The majority of patients using this device are older than 60 and sometimes they need to repeat the procedure more than once.

_ Although the device collects valuable information, some conditions, which might be symptoms of more serious heart problems, go unnoticed. (ex. certain types of arrhythmias).

_ They get frustrated because they cannot find the time to explain all the details of the procedure to their patients and they feel patients’ dissatisfaction and uncertainty.

_ “It takes too long to get the data that we need”. Patients must return the device back to the medical center, then the technicians extract the data from the device by connecting it to their system, then the data are included within the patient’s records and saved in databases. Only then doctors are able to have a clear vision of what is going on with their patients.

# Compared with other Devices for Heartbeat Monitoring:

Despite the fact that the Holter monitor is one of the most used devices to measure the heartbeat even today, for a few years, other heartbeat monitors have been coming onto the market offering significant improvements for patients. This is the case of Zio Patch, from iRythm Tech.

But even though this new monitoring option is more manageable, less cumbersome, and has a higher level of data accuracy than the original Holter Monitor, it requires longer use than the Holter Monitor to detect the same number of conditions. This makes procedures a bit harder to perform with both children and the elderly.

As mentioned before, many smartwatches and mobile phones can provide a service similar to heartbeat monitors but are not capable of perceiving certain abnormalities that may indicate heart problems. They are a very good aid for home use because they measure many different parameters such as oxygen saturation, thanks to the use of sensors including accelerometers, gyroscopes, and GPS.

# Conclusions and Challenges

Finding the ideal device is not easy. Both patients and medical professionals have needs that should be met in order to succeed when going through these procedures, and it seems that if you try to improve one part, the other will get worse.

For me, the main challenge is to rethink the design of the device. It is clear to me, that it needs to be something free of technical assistance. The ease of use must be a basic requirement due to the characteristics of the patients who generally use this type of device.

On the other hand, it should offer some kind of interface that could deliver clear information to patients, making them understand what data is being collected. This is already offered on smartphones or smartwatches.

And last but not least, the data collection. The more accurate data collection in the shortest possible time, the medical professionals will be able to deliver better diagnoses in less time. In this way, they will be able to care about the psychological needs of patients before, during, and after the procedures. In my opinion, finding a way to shorten the process from data collection until professionals can access and evaluate this data, should be a priority.

# References:

https://www.healthline.com/health/holter-monitor-24h#results

https://www.mayoclinic.org/tests-procedures/holter-monitor/about/pac-20385039

https://medicompinc.com/introducing-newly-improved-holter-monitoring-system-medicomp/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3882198/#:~:text=Extending%20arrhythmia%20monitoring%20periods%20results,patients%20than%20the%20Holter%20monitor.

https://noticiasdelaciencia.com/art/9874/mediciones_cardiacas_constantes_con_un_nuevo_y_pequeno_dispositivo_adhesivo

by Lucia Perez Diego -

Data visualization in health systems.

Knowledge is power. Nowadays all kinds of sensors are continuously gathering data about our behavior, our physical activity levels, and different health indicators like blood pressure, blood oxygen levels, and more. All of this can be monitored through phones, smartwatches and other IoT devices conceived specially for medical applications

What happens with all this data? Raw data is useless if we don’t know what we are looking for.

A good strategy for data visualization is the key to the proper use of data.

When trying to create a better user experience for both health professionals and patients, we need to distinguish which information is needed for each side and how it should be presented:

Medical Staff:  An overloaded system can be helped by synthesizing and simplifying the amount of data that the doctors need to analyze.

A good presentation of numbers and facts can help the doctors identify low-risk patients faster, so they can prioritize and leave more time for those who really need it.

Patient: Being a patient is already a stressful situation. Medical terms that patients are not familiar with and uncertainty don’t help make the situation more comfortable. Feeling lost and uneducated is not the feeling of reassurance that a medical visit should give.

Presenting facts and figures in a clear and didactic way will make the patient feel included in the process and learn about the condition, gaining implications for the treatment.

_ Literature

http://ehealthmasterminds.com/visualize-your-data/

https://www.eecs.harvard.edu/~kgajos/papers/2020/fischer20visualization.pdf

https://www.therapeuticshub.com/data-in-healthcare/