PowerPoint

A Trial of Telehealthcare for
Diabetic in Taiwan – how important
is each behavior of the AADE7?
Prof. Feipei Lai
Medical Informatics Laboratory
Graduate Institute of Biomedical Engineering and Bioinformatics
Computer Science and Information Engineering
Electrical Engineering
National Taiwan University
Taipei, Taiwan
EITC-Bio 2012/10/27
1
Outline




Introduction
Motivation
Roadmap
Telehealthcare
 Diabetes
 Heart Failure
 Weight Losing
 Conclusion
 Future Work – Patient Portal
 Acknowledgement
2
Introduction - National Taiwan University
Hospital
1895
• 1912
3
• 1991
Human Resources (2007.03.31)
Headquarter
VS
*544
Resident
592
Nurse
2,104
Engineer
772
administrative
personnel
583
Worker
758
Total
*213 VS with professorship
5,353
4
核心價值 Core Value




正直誠信 Integrity
創新卓越 Innovation to excellence
團隊合作 Teamwork
健康尊嚴 Health & Dignity
5
Services (headquarter only)
 Bed: 2564, ~90% occupancy rate
 Outpatient: ~9000 daily
 Emergency: ~300 daily
6
NTU Hospital Chain
Headquarter
Jinshan Branch
Merged in 2010/10
Hsinchu 2011/7
Chutung 2011/7
Yunlin Branch
Merged in 2004/4
7
Beihu Branch
Merged in 2004/8
Motivation




Aging Society
Escalating of Medical Expense
Continuous Care
Reducing Length of Stay in NTUH & Increasing the
Turnover Rate
 Improvement of Medical Devices MIT
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9
Telehealthcare Information System







Diabetes Care
COPD Care
Heart Failure Care + Gastrointestinal Postoperative Care
Weight Losing Care
Hospice Care
S-Pulse program
HIV Case Management + Mental Stress Case Management
10
11
Telehealthcare Information Systems
(2/2)
 Integration
 Sharing user interface components
 Ex: User interface is the same on ‘Sport Record’ in Diabetes
Care and Weight Losing Care
 Sharing user data
 User data are shared by all subsystems
 User can receive all/some of the services (Diabetes
and Weight Losing, etc.) at the same time
12
DM
 In Taiwan, 20-79 years old, 140M (6%) Diabetes
Patients
 If controlled well, can reduce 40-60% comorbidity and
22% medical expense
 Mortality 39.2/100,000
13
Telehealthcare for DM
 Diabetes Care
 Key in (Web Site & App)
 Bluetooth (to cellphone) and 3G (to data center)
 Standard & Open System (HL7, LOINC)
14
Telehealthcare for DM
 Glucose
15
Telehealthcare for DM
 Glucose Analysis every 3 months
16
Telehealthcare for DM
 Heart rate
17
Telehealthcare for DM
 Personalized Control Targets
18
DM Case Management
 Diabetes Care
 Abnormal data warning (send SMS message to case
managers)
 Phone Call
 Message in the web site
 Examination Report (from EMR)
 Health Education Information
19
DM Case Management
• Abnormal data warning (web site, send SMS message to
case manager)
20
DM Case Management
• Message
21
DM Case Management
 Examination Report (EMR)
22
DM Case Management
 Health Education Information
23
Current Results
Duration 2011/9/5 ~ 2012/10/05
Group 1. Control
Group 2. Blood Sugar not well controlled
Group 3. Blood Sugar well controlled
Total
Case closed
24
No.
74
94
10
178
5
Age
Sex
Male
Female
DM type
Type I
Type II
VS.
Dr. Chuang
Dr. Chang
Dr. Chiang
Others
Device
Fora D40
Other
Non-intervention Group
(n=74)
51.3±14.3
Intervention Group
(n=104)
52.3±12.50
44 (59.5%)
30 (40.5%)
55 (52.9%)
49 (47.1%)
13 (17.6%)
61 (82.4%)
26 (25.0%)
78 (75.0%)
45 (60.8%)
19 (25.7%)
10 (13.5%)
0 (0%)
65 (62.5%)
28 (26.9%)
8 (7.7%)
3 (2.9%)
_
_25
47 (45.2%)
57 (54.8%)
Intervention group
HbA1C (%)
0.0~0.2
0.3~0.4
0.5~0.6
0.7~0.8
0.9~1.0
1.1~1.2
1.3~1.4
1.5~1.6
1.7~1.8
1.9~2
≧2.1
Total
Intervention Group (n=94)
Same
Better
Worse
21
11
5
9
5
8
1
6
1
6
0
5
0
0
0
2
1
2
0
8
3
21 (22.3%) 57 (60.6%) 16 (17%)
26
Non-Intervention group
HbA1C (%)
0.0~0.2
0.3~0.4
0.5~0.6
0.7~0.8
0.9~1.0
1.1~1.2
1.3~1.4
1.5~1.6
1.7~1.8
1.9~2
≧2.1
Total
Non-Intervention Group (n=74)
Same
Better
Worse
13
13 (17.5%)
10
3
5
4
4
0
4
3
5
7
2
1
1
0
2
0
2
0
8
0
43 (58.1%) 18 (24.3%)
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HbA1C Variation
％
8.8
8.6
8.7
8.4
8.4
8.2
8
7.8
intervention group
7.9
non-intervention group
7.6
7.6
7.4
7.2
7
Zero
Three
2011/09/05~2012/10/05
Intervention group: 94/104
Non-intervention group: 73/74
Month
HbA1C Variation
％
8.8
8.6
8.7
8.4
8.4
8.2
8
7.8
7.6
7.4
8.2
7.9
intervention group
7.6
non-intervention group
7.5
7.2
7
6.8
Zero
Three
Six
2011/09/05~2012/10/05
Intervention group: 85/104
Non-intervention group: 71/74
Month
HbA1C Variation
％
9
8.8
8.6
8.6
8.4
8.4
8.2
8
7.8
7.6
7.4
8.3
8.1
7.9
intervention
non-intervention
7.6
7.5
7.4
7.2
7
Zero
Three
Six
2011/09/05~2012/10/05
Intervention group: 60/104
Non-intervention group: 62/74
Nine
Month
HbA1C Variation
％
9
8.8
8.6
8.6
8.4
8.4
8.2
8
7.8
7.6
7.4
8.3
8.3
8.1
intervention
7.9
non-intervention
7.6
7.5
7.6
7.4
7.2
7
Zero
Three
Six
Nine
2011/09/05~2012/10/05
Intervention group: 25/104
Non-intervention group:31 18/74
Twelve
Month
HbA1C Variation
％
9
8.5
8.5
8
7.9
7.7
7.8
7.8
group 2
7.5
group 3
7
6.8
6.8
6.7
6.5
6.6
6.7
6
Zero
Three
2011/09/05~2012/10/05
group 2: 18/94
group 3: 7/10
Six
Nine
Twelve
Month
AADE7
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Healthy Eating
Being Active
Monitoring
Taking Medication
Problem Solving
Reducing Risks
Healthy Coping
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AADE7 - Healthy Eating
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AADE7 - Being Active
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AADE7 - Monitoring
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High Blood Glucose
Low Blood Glucose
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Complication
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AADE7 - Reducing Risks
Foot
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Results – Fisher Score Order (used in
SVM)
Rank
Evaluation Item (394)
Feature Name
1 Healthy Coping
Compassion for patient
2 Monitoring
Glucometer’s accuracy
3 Monitoring
Blood collection method
4 Healthy eating
Less fried food
5 Monitoring
Expiration of blood glucose strips
6 Monitoring
Low frequency of taking blood glucose
7 Reducing risks
Plan the treatment on foot problem
8 Monitoring
Taking blood glucose when getting sick
9 Reducing risks
Inadequate treatment on foot problem
10 Reducing risks
Status of dealing with those factors causing
risks
42
Results – Number of features in each
AADE7 aspect
AADE7 Aspect
Number of Features Number of Records
(2011-07-01 ~ 2012-05-30)
Healthy eating
46
1352
Being active
44
945
Monitoring
65
940
Taking medication
57
834
Problem solving
56
377
Reducing risks
108
42
Healthy coping
18
80
43
Results – The weight in each AADE7
aspect
Rank
1
2
3
4
5
6
7
AADE7 aspect
Taking medication
Healthy eating
Problem solving
Being active
Monitoring
Reducing risks
Healthy coping
44
Weight
0.26
0.21
0.17
0.13
0.11
0.07
0.05
45
Heart Failure Care (HFC)
46
HFC Case Management
47
HFC Case Management
48
HFC Case Management
49
HFC Case Management
50
HFC Case Management
51
HFC Case Management
52
HFC Case Management
53
HFC Case Management
54
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Weight Losing
 Weight Losing Care
 Key in (web site)
 App web site
 Weight Record
 Weight
 Body Fat
 BMI
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Weight Losing
 Diet Record
 Users learn how to calculate the amount of food on six
main kinds of staple, milk, protein, oil, vegetable and
fruit in the online courses as well as from case manager.
 By uploading the amount of food, the calorie will be
calculated automatically.
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Weight Losing
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Weight Losing
 Detailed Diet Record
 Case Managers give
users suggestions
(previous page)
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Weight Losing
 Sport Record
 Consumption
 Minutes
 Pedometer
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Weight Losing
 Weight Losing Courses
 Online Courses
 Weight Losing Education Information
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10% weight reduction by 12 weeks
Total
32
closed
10
finish
6
Before (kg)
After (kg)
Goal
quit
4
91.7
81.8
O
Going on
22
110.2
98.9
O
82.5
75
X
70.2
66.9
X
103
93
O
71.5
65.4
X
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Conclusion

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Telehealthcare will be a must in the future.
Enabling Preventive & Early Diagnosis
ICT helps Personalization
Telemedicine still blocked by law - the falling of
Taiwan.
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Future work
 Social Network – patient support group
 The users can know more other users in the same
service group. Their conditions will be improved by
encouraging each other.
 Clinical Decision Support System (CDSS) to reduce the
workload of case managers and physicians
 Computer Aided Diagnosis helps screen cases
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Acknowledgement
 Grant support from NSC, MoEdu, NTU, NTUH
 Participants: Physicians, Nurses from NTUH, members
of NTU Medical Informatics Lab., Center for
Telehealthcare, NTUH, members of NSC project
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