2 APPLIEDHEALTH INTRODUCTION 6 PERSPECTIVES 11 PROJECTS 29. Introduction to the project 7 Introduktion til projektet 8 Einführung in das Projekt 10

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2 2 APPLIEDHEALTH INTRODUCTION 6 Editor: James Norwood Publishing Editors: Nicole Wayland, James Norwood Design concept: Kristen Utne, James Norwood Graphic Design: Kristen Utne Photographer: Nicolai Brix, James Norwood Translation: Easy Translate Cover Graphics: Stupid Studio Printed by Narayana Press ISBN Articles by: James Norwood (24,32,52,55,56,58,61,70) Maj Jørgensen (12) Felix Prell (16,36,40,42,44) Franziska Uhing (20,28,46,48,50) Erik Østergaard (64) Elisabeth Agerbæk (28) This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights to translation, reprinting, re-use of illustrations, recitation, broadcasting, reproduction on microfilms or in other ways, and storage in data bases. For any kind of use permission of the copyright owner must be 2014 Printers Details Introduction to the project 7 Introduktion til projektet 8 Einführung in das Projekt 10 PERSPECTIVES 11 OUH 12 UKSH 16 FH Kiel 20 EAL 24 PROJECTS 29 Process Insights 28 OUH 32 UKSH 36 FH Kiel 46 EAL 52 Odense Open DeviceLab 70

3 4 5 ACKNOWLEDGEMENT Thanks to all collaboration partners including Odense University Hospital (OUH), Erhvervsakademiet Lillebælt (EAL), Fachhochschule Kiel (FH Kiel), University Hospital Schleswig-Holstein (UKSH). UNIVERSITY HOSPITAL SCHLESWIG-HOLSTEIN Felix Prell (Project Manager) Almut Kalz, Georg Böhler, Walter Jonat, Klaus-Peter Jünemann, Diethild Melchior, Daniar Osmonov Baun Kristensen, Pavels Konstantinovs,, Jesper Fromm Jensen, Liga Fridmane, Michael Sjørup Christiansen, Kirstine Grøntvedt Christiansen, Gratiani Bejinariu Thanks also to Interreg 4A. ODENSE UNIVERSITY HOSPITAL Department for operation optimization and IT, Lean & Innovation Jesper Lakman (Project Leader) Maj Jørgensen, Rikke Lyngholm Hansen-Christensen, Christian Tvede Intensive Care Unit (ICU) VITA Tove Fog, Susan Feldborg Gynækologisk Obstetrisk Department Christina Vinter, MD, PhD Family Clinic of the region of Southern Denmark Inge Olga Ibsen Rehabilitation Department Trine Pi Bassett, Peter Dirch Jørgensen FH KIEL Franziska Uhing (Project Manager) Melanie Lucht, Malte Boedecker, Julia Lyhs, Patrick Rupert-Kruse ERHVERVSAKADEMIET LILLEBÆLT James Norwood (Project Manager) Torben Lindegaard Hansen, Jan Lund, Ulla Pedersen Michael Lundorff Hansen, Elisabeth Agerbæk, Adam Montandon, Morten Sabro Damgaard, Lars Bojen Nielsen, Erik Østergaard, Bjarne Slipsager, Kirsten Kasch BA E-Concept Development Andreea Mironiuc, Maris Pagasts, Thomas Eriksson, Eliza Kasarenoka, Andreas Wiberg Sode, Ernesta Civilkaite, Jean Popescu, Thijs Van de Wouw, Timea Kovacs, Bogdan Ciocsan, Line Nguyen, Viktors Leidums, Viktorija Dokucajeva, Kristina Freimane, Kamile Zubaviciute, Frederik Gaarddal Wilkens, Raminta Vdovycaite, Melissa Ellen Margaret Vardy, Monika Siwek, Mahdi Sarwari, Beslind Polisi, Adina Rizga, Martin Lillholm Pico Pedersen, Martin Skjærup Nielsen, Mads Snedevind Nielsen, Marie-Louise Merser, Bjørn Max Lykke, Keith Ryan Lopez, Michael Erdmann Lindberg, Esben Vierø Larsen, Sanne Riber BA Web Development Chris Hermann Christensen, Tuan Tony Hoang Dieu, Mathias Rando Hansen, Sander Skovgaard Hansen, Quoc Thai Denny Huynh, Emil Taek Holm Jepsen, Jesper Kryger Martinussen, Thomas Dyrehauge Nielsen Rasmus Faddersbøll PROJECT PARTNERS Skrillingeskolen, Middelfart Kommune TakeDesign, University College Lillebaelt, iform NETWORK PARTNERS Woerk, Appfactory, MedTech Innovation Center, Mikro Værkstedet, 10:30 Visuel Kommunikation, MediTeam, Idéklinikken StupidStudio - Branding - OUH Odense Universitetshospital Svendborg Sygehus

4 6 7 INTRODUCTION INTRODUCTION INTRODUKTION EINFÜHRUNG UK Mobile health or just mhealth is the use of smartphones and tablets in health care, diagnosing and treatment. It is an industry that worldwide is growing rapidly year by year. In Denmark and Germany, it is an established and ever-growing industry with an annual turnover of several billion euros, which allows patients and clinicians to gain better and more relevant information for treatment, self-monitoring, access to hospitals, workflows and much more. Odense University Hospital, University Hospital Schleswig-Holstein Campus Kiel, Erhvervsakademiet Lillebælt, and Fachhochschule Kiel started this two-year project to develop a number of mhealth applications in selected clinical areas. The project aimed to identify existing national and international mhealth applications and explore the possibilities of establishing new, innovative services in a dialogue between patients and hospitals. THE PROJECT The overall objective was to create specific new tools for clinicians and patients in the form of applications (apps) for smartphones in three areas: treatment, communication and diagnostics. The project focused on developing four to eight prototypes in close cooperation with users from hospitals, students from the two schools and companies from the industry. The objective was that the two IT departments at the hospitals in Kiel and Odense would advance their skills in connection to updating, developing and servicing the apps developed by the industry. In this way, it is ensured that the developed apps will not become obsolete and useless but instead can be developed and adapted in collaboration with both users and the service organizations at the hospitals. Furthermore, safety, operational options, integration with existing systems and overall IT strategies would be taken into account. Ownership would also be with the IT departments in the hospitals.x During the project phases, the target groups were invited to specific courses of development to ensure that the development was user-driven and tested. The clinicians were involved in the idea creation and discussion of the challenges.

5 8 9 INTRODUKTION DK Mobile health - eller blot mhealth - er brug af smartphones og tablets i sundhedspleje, diagnosticering og behandling. Det er en branche, som vokser på globalt plan år for år. I Danmark og Tyskland har branchen allerede etableret sig og vokser konstant med en årlig omsætning på adskillige milliarder euro, og den giver patienter og læger mulighed for bedre og mere relevante oplysninger vedr. behandling, egen kontrol, adgang til sygehuse, arbejdsprocesser og meget andet. Odense Universitetshospital (OUH), Universitätsklinikum Schleswig-Holstein-Campus Kiel (UKSH), Erhvervsakademiet Lillebælt (EAL) og Fachhochschule Kiel påbegyndte dette to-årige projekt til udvikling af en række mhealth-applikationer på udvalgte kliniske områder. Projektet havde til hensigt at identificere eksisterende nationale og internationale mhealthapplikationer og undersøge mulighederne for at indføre nye, innovative tjenester i dialog mellem patienter og sygehuse. udvikling af fire til otte prototyper i tæt samarbejde med brugere på sygehuse, studerende på to skoler og virksomheder i branchen. Det var målet, at de to IT-afdelinger i hhv. Kiel og Odense skulle udvikle deres kompetencer vedrørende opdatering, udvikling og servicering af apps, som er udviklet af branchen. På denne måde sikres det, at de udviklede apps ikke bliver forældet og overflødig, men i stedet kan udvikles og tilpasses i samarbejde med både brugere og serviceafdelinger på sygehusene. Derudover skulle der også tages højde for sikkerhed, driftsmæssige muligheder, integrering med eksisterende systemer og overordnede IT-strategier. Ejerskabet skulle ligge hos IT-afdelingerne på sygehusene. I løbet af projektfaserne blev målgrupper inviteret til særlige udviklingskurser for at sikre, at udviklingen var brugerdrevet, og at den blev testet. Lægerne blev involveret i idefasen og i diskussionen af de lægemæssige udfordringer. PROJEKTET Det overordnede mål var at skabe nye værktøjer til læger og patienter i form af applikationer (apps) til smartphones på tre områder: behandling, kommunikation og diagnosticering. Projektets fokus var på

6 10 EINFÜHRUNG 11 DE Mobile Health - oder einfach mhealth - ist die Anwendung von Smartphones und Tablets in Gesundheitswesen, Diagnose und Behandlung. Es ist eine Branche, die weltweit von Jahr zu Jahr stark wächst. In Dänemark und in Deutschland ist es eine eingeführte und ständig wachsende Branche mit einem Jahresumsatz von mehreren Milliarden Euro, die es Patienten und Klinikerärzten ermöglicht, bessere und relevantere Informationen für die Behandlung, die Selbstüberwachung, den Zugang zu Krankenhäusern, die Arbeitsabläufe und vieles mehr zu erlangen. Das Universitätskrankenhaus Odense, das Universitätskrankenhaus Schleswig-Holstein Campus Kiel, die Erhvervsakademiet Lillebælt und die Fachhochschule Kiel starteten dieses auf zwei Jahre angelegte Projekt, um für ausgewählte klinische Bereiche eine Anzahl von mhealth-anwendungen zu entwickeln. Das Projekt zielte darauf ab, bestehende nationale und internationale mhealth-anwendungen zu identifizieren und die Möglichkeiten zur Einführung neuer, innovativer Dienstleistungen für einen Dialog zwischen Patienten und Krankenhäusern zu erkunden. DAS PROJEKT Das allgemeine Ziel bestand in der Schaffung spezifischer neuer Tools für Klinikärzte und Patienten in der Form von Anwendungen (Apps) für Smartphones in den drei Bereichen Behandlung, Kommunikation und Diagnostik. Das Projekt konzentrierte sich auf die Entwicklung von vier bis acht Prototypen in enger Zusammenarbeit mit Anwendern in Krankenhäusern, von Studenten der beiden Fachhochschulen und von Unternehmen der Branche. Ziel war, dass die beiden IT-Abteilungen der Krankenhäuser in Kiel und Odense ihre jeweiligen Kenntnisse in Bezug auf Aktualisierung, Entwicklung und Instandhaltung der von der Industrie entwickelten Apps verbessern. Auf diese Weise wird gewährleistet, dass die entwickelten Apps nicht veraltet und nutzlos werden, sondern dass sie vielmehr in Zusammenarbeit sowohl mit den Anwendern als auch mit den Instandhaltungsabteilungen der Krankenhäuser weiterentwickelt und angepasst werden. Außerdem würden die Sicherheit, betriebliche Optionen, die Integration in bestehende Systeme und die allgemeine IT-Strategien mit berücksichtigt werden. Die Verantwortung würde ebenfalls bei den IT-Abteilungen der Krankenhäuser liegen. Um zu gewährleisten, dass die Entwicklung nutzerorientiert und getestet ist, wurden die Zielgruppen während der Projektphase zu bestimmten Entwicklungspfaden eingeladen. Die Klinikeärzte wurden in die Ideenfindung und die Durchsprache der klinischen Herausforderungen eingebunden. PERSPECTIVES

7 12 13 PERSPECTIVE OUH By Maj Jørgensen UK Digital media, including mobile electronic health tools such as mobile phones and telemedicine technologies, are rapidly transforming the face of health service delivery in Denmark and Germany, as well as around the world. In short, mhealth will have a huge impact on how healthcare is delivered. It offers opportunities to address one of the most pressing global challenges: making healthcare more accessible, faster, better and less expensive. Mobile technologies are accelerating trends in healthcare. Three major trends already happening in healthcare lend themselves to the revolution in mobile technology: Ageing populations: Ageing populations and chronic illness are driving regulatory reform. Public sector health care is seeking better access and quality, and it is looking to the private sector for innovation and efficiency. Innovative mhealth initiatives improve access and quality while reducing cost. The platform: The foundations of the industrialisation of health care are already in place electronic patient journals, remote monitoring and communications. The idea of care anywhere is already emerging. The platform for mhealth is set. Personalisation: Health care, like other industries, is getting personal. mhealth can offer personal toolkits for predictive, participatory and preventive care. Expectations are high that mobile technology will help to transform our costly health care behemoths into less expensive, prevention-based and patient-focused systems; however, there is no quick fix! And this is also true concerning mhealth. New technology is not enough. The widespread adoption of mhealth will require changes in the behaviour of actors seeking to protect their interests. The challenge will be even greater for innovators because of the improvements that mhealth can bring (e.g., patient-centred care and a greater focus on prevention), and it will involve disruption of how health care is provided. To succeed, innovators must manoeuvre through culturally conservative, highly regulated and fragmented yet monopolistic systems that often provide contradictory incentives. That being said, future prospects of mhealth are promising. In Denmark, there is an increased political interest in mhealth, including its potential for promoting more patient-centred, preventive and cost-effective care.

8 14 15 DK Digitale medier, inklusive mobile elektroniske sundhedsværktøjer såsom mobiltelefoner og telemedicinske teknologier, forandrer hastigt udseendet af de sundhedstjenester, der leveres i Danmark, Tyskland og resten af verden. Kort sagt får mhealth meget stor indflydelse på leveringen af sundhedspleje. Den tilbyder muligheder til håndtering af en af de mest presserende udfordringer på verdensplan: at gøre sundhedspleje mere tilgængelig, hurtigere, bedre og billigere. Mobile teknologier sætter fart på tendenserne i sundhedsplejen. De tre vigtigste tendenser, der pågår i øjeblikket i sundhedsplejen, er med til at bane vejen for den mobile teknologis revolution: Aldrende befolkninger Aldrende befolkninger og kroniske sygdomme er årsag til lovmæssige reformer. Den offentlige sundhedssektor forsøger at blive mere tilgængelig og at højne kvaliteten og kigger mod den private sektor med henblik på innovation og effektivitet. Innovative mhealth-initiativer forbedrer tilgængeligheden og kvaliteten, mens omkostningerne reduceres. Platformen: Grundlaget for industrialiseringen af sundhedsplejen er allerede på plads - elektroniske patientjournaler, fjernovervågning og kommunikation. Ideen om pleje overalt er ved at vinde indpas. Platformen for mhealth er klar. Personliggørelse: Sundhedspleje bliver - på linje med andre brancher - gjort personlig. mhealth kan tilbyde personlige værktøjssæt til deltagende og forebyggende pleje, både før og efter behandling. Der er høje forventninger til, at mobil teknologi vil bidrage til at forandre vores dyre sundhedsmastodonter til billigere, forebyggelsesbaserede systemer med patienten i centrum; der er dog ingen nemme løsninger! Det gælder også for mhealth. Ny teknologi er ikke nok. Den udbredte tilegnelse af mhealth kræver adfærdsændringer hos de aktører, der prøver på at beskytte deres interesser. Udfordringen bliver endda endnu større for udviklerne pga. de forbedringer, som mhealth kan tilvejebringe (f.eks. pleje med patienten i centrum og større fokus på forebyggelse), hvilket vil være med til at skabe en helt ny form for sundhedspleje. For at det skal lykkes, skal udviklerne manøvrere gennem en konservativ kultur, monopolistiske systemer, der er gennemreguleret, men alligevel opsplittede, og som ofte genererer modsatrettede incitamenter. Det skal dog også siges, at fremtidsperspektiverne for mhealth er lovende. I Danmark er der øget politisk interesse for mhealth, herunder dets potentiale for fremme af forebyggende og billigere pleje, der har patienten i centrum. DE Digitale Medien - darunter mobile elektronische Gesundheitstools wie Mobiltelefone und telemedizinische Technologien - transformieren das Gesicht der Gesundheitsdienste in Dänemark und in Deutschland sowie überall auf der Welt rasant. Kurz gesagt, mhealth wird eine riesige Auswirkung darauf haben, wie Gesundheitsdienste künftig erbracht werden. Sie bieten Chancen, die drängendsten weltweiten Herausforderungen - Gesundheitsdienste leichter zugänglich, schneller, besser und billiger zu machen - zu bewältigen. Mobile Technologien beschleunigen Trends im Gesundheitswesen. Drei wichtige Trends, die sich im Gesundheitswesen bereits abzeichnen, bieten sich für eine Revolution in der Mobiltechnologie geradezu an: Die alternde Gesellschaft: Die alternde Gesellschaft und chronische Krankheiten treiben aufsichtsrechtliche Reformen voran. Das öffentliche Gesundheitswesen strebt nach besserem Zugang und höherer Qualität und schaut im Hinblick auf Innovation und Effizienz auf den privaten Sektor. Innovative mhealth-initiativen verbessern den Zugang und die Qualität bei geringeren Kosten. Die Plattform: Die Grundlagen für eine Industrialisierung des Gesundheitswesens liegen bereits vor - elektronische Patientenjournale, Fernüberwachung und Kommunikation. Es kommt bereits die Idee von Gesundheitsdienste überall auf. Die Plattform für mhealth besteht. Personalisierung: Gesundheitsdienste, wie andere Branchen auch, werden individualisiert. mhealth bietet persönliche Toolkits für prognostizierende, partizipative und präventive Gesundheitsdienste. Die Erwartungen sind hoch, dass die Mobiltechnologie dazu beitragen kann, unsere teuren Gesundheitsdienstkolosse in preiswertere, auf Vorbeugung basierende und patientenorientierte Systeme zu transformieren; schnelle Lösungen sind aber nicht zu erwarten! Und das gilt auch für mhealth. Neue Technologien reichen dafür nicht aus. Die breite Annahme von mhealth wird Änderungen des Verhaltens der Akteure erfordern, die ihre Interessen zu schützen versuchen. Wegen der Verbesserungen, die mhealth bringen kann (z. B. auf Patienten konzentrierte Gesundheitsdienste und ein größeres Schwergewicht auf Prävention), wird die Herausforderung für die Innovatoren sogar noch größer, es wird nämlich die Art und Weise gestört, in der Gesundheitsdienste geleistet werden. Um erfolgreich zu sein, wird es erforderlich sein, dass die Innovatoren durch kulturell konservative, hochgradig regulierte und fragmentierte und dennoch monopolistische Systeme manövrieren, die oftmals gegenläufige Anreize bieten. Dennoch sind die Aussichten für die Zukunft von mhealth vielversprechend. In Dänemark gibt es ein gesteigertes politisches Interesse an mhealth, einschließlich seines Potenzials für mehr auf Patienten konzentrierte, präventive und kostengünstigere Gesundheitsdienste.

9 16 17 PERSPECTIVE UKSH By Felix Prell UK We live in a time in which time itself has become a scarce commodity, especially doctors time. This is a trend that has been ongoing for a number of years, and there is no end in sight. The demographic changes in most of Europe are transforming our population pyramid into an urn form. For the medical profession, this means mainly two things: there will be more and more old people and there will be fewer and fewer doctors to treat them. This means that the average time one doctor can spend on one patient will decrease significantly. As this is an inevitable development, the task of paramount importance for medical doctors, clinics, hospitals and the entire health care system becomes finding an answer to the question of how to maintain adequate patient care with less time. Given the demographic developments we are facing, the answer to this question can be only technology. In the past, technological evolution in the field of medicine has often been a slow, tedious and very expensive endeavour. With the rise of mobile technology, however, this is changing drastically. Smartphones, tablets, wearables and all kinds of sensors have become a ubiquitous commodity. Development is happening at an amazing speed, and compared to regular medical technology, the gadgets are often surprisingly affordable. This new technology, if used sensibly, has the very real potential to solve the medical demographic crises we are facing. It is time to seize the opportunity to take health care to the next level.

10 18 19 MOBILE TECHNOLOGY, HAS THE POTENTIAL TO SOLVE THE MEDICAL DEMOGRAPHIC CRISES DK Vi lever i en tid, hvor tid i sig selv er blevet en mangelvare, især lægernes tid. Dette er en tendens, som har eksisteret i et antal år, og der er ikke udsigt til, at det ændrer sig. De demografiske ændringer i de fleste europæiske lande ændrer formen af vores befolkningspyramide, så den ligner en urne. Fra et lægemæssigt synspunkt betyder dette hovedsageligt to ting: der bliver flere og flere ældre personer og færre og færre læger til at behandle dem. Det betyder, at den gennemsnitlige tid en læge kan tillade sig bruge på en patient falder markant. Da det er en uundgåelig udvikling, bliver den allerstørste opgave for læger, klinikker, sygehuse og hele sundhedssektoren at finde et svar på spørgsmålet om, hvordan man fastholder et passende niveau for patientpleje på kortere tid. Givet de demografiske udviklinger som vi står overfor, kan svaret på dette spørgsmål kun være teknologi. Tidligere var teknologisk udvikling på det medicinske område en ofte langsom, besværlig og meget dyr opgave. Med den mobile teknologis komme har dette dog ændret sig drastisk. Smartphones, tablets, bærbare enheder og alle former for sensorer findes nu overalt. Udviklingen sker med en utrolig hastighed, og sammenlignet med almindelig lægelig teknologi er apparaterne ofte overraskende billige. Hvis den bliver brugt fornuftigt har denne nye teknologi potentiale til at løse den lægemæssige demografiske krise, som vi står overfor. Det er nu, vi skal gribe chancen og få det til at ske - at bringe sundhedsplejen op på et nyt niveau. DE Wir leben in einer Zeit, in der die Zeit selbst zu einem knappen Gut geworden ist, insbesondere die Zeit von Ärzten. Dieser Trend besteht bereits seit ein paar Jahren, und es ist kein Ende abzusehen. Der demographische Wandel im größten Teil Europas transformiert unsere Bevölkerungspyramide in eine Urnenform. Für die medizinischen Berufe bedeutet das hauptsächlich zweierlei: Es wird immer mehr alte Menschen geben und immer weniger Ärzte, um sie zu behandeln. Das heißt, dass die Zeit, die ein Arzt für einen Patienten im Durchschnitt aufwenden kann, beträchtlich sinken wird. Da dies eine unvermeidliche Entwicklung ist, erhält die Frage, wie eine adäquate Patientenversorgung bei weniger Zeit gewährleistet werden kann, für Ärzte, Kliniken, Krankenhäuser und das gesamte Gesundheitssystem eine überragende Bedeutung. Angesichts der demographischen Entwicklung, der wir gegenüberstehen, kann die Antwort auf diese Frage nur lauten: Technologie. In der Vergangenheit war technologische Entwicklung auf dem Gebiet der Medizin ein oft langsames, mühevolles und sehr kostspieliges Unterfangen. Mit dem Aufkommen der mobilen Technologie dagegen ändert sich das drastisch. Smartphones, Tablets, Wearables [tragbare Geräte] und alle Arten von Sensoren sind zu einer überall erhältlichen Ware geworden. Die Entwicklung erfolgt mit einer erstaunlichen Geschwindigkeit, und im Vergleich zu regulärer medizinischer Technologie sind die Geräte häufig überraschend erschwinglich. Diese neue Technologie, wenn sie mit Verstand verwendet wird, hat das sehr reale Potenzial, die demographische medizinische Krise, der wir gegenüberstehen, zu lösen. Es ist Zeit, die Chance zu ergreifen und Wirklichkeit werden zu lassen - Gesundheitsdienste auf die nächst höhere Stufe zu heben.

11 20 21 PERSPECTIVE FH KIEL By Franziska Uhing UK Defining one s own challenge within the project scope of mhealth and collaborating institutes is an interesting task. To start off with the difficult part, a media-producing unit needs content and a specific target. But the idea of Interreg is not a ticket system; it is about exploring fields and defining new targets while cooperating with partners from a different subject area in this case, medicine, which certainly is a rich field for collecting, visualising and communicating patient data and medical knowledge. While performing research, one realises that there are telemedical projects sprouting up like mushrooms and becomes fascinated by the idea of participating in this innovation process. While finding out what features and services of a mobile device might be useful for medical purposes, one addresses possible partners who might be willing to join the quest. Innovative doctors like Prof. Dr. Jünemann, Prof. Dr. Jonat, and Dr. John were similarly convinced of the project s potential and willing to spend time exploring and researching mobile devices for mhealth. It takes time to get together on a working level, especially if the project is one that is reserved for the researchers spare time. This is where rapid prototyping with design mock-ups really helps to get a common idea of the possible product and its functions. In fact, usability is crucial. The next challenge is at the production level. With current mobile devices, the question of platforms and operating systems is a relevant one for a producer, and a web-based solution that targets multiple platforms was the answer in our case. The knowledge gained from this process was, again, fruitful for the department additional benefits of the project include the update of course contents in curriculum and the involvement of students in production processes, where possible. Overall, development on many levels and partners with inspiring ideas to share was very interesting indeed.

12 22 23 RAPID PROTOTYPING WITH DESIGN MOCK-UPS REALLY HELPS TO GET A COMMON IDEA DK At definere ens egen udfordring indenfor mhealth-projektets omfang og samarbejdende institutter er en spændende opgave. For at begynde med den svære del har en medieproducerende enhed behov for indhold og et specifikt mål. Men ideen om Interreg er ikke et billetsystem; det drejer sig om at undersøge områder og definere nye mål, mens der samarbejdes med partnere fra andre emneområder - i dette tilfælde medicin, som uden tvivl er et rigt område til indsamling, visualisering og kommunikering af patientdata og lægefaglig viden. Når man er i gang med at forske, finder man ud af, at der er telemedicinske projekter, som spirer frem som svampe, og man fascineres af ideen om at tage del i denne innovative proces. Mens man prøver at finde ud af hvilke funktioner og tjenester på en mobil enhed, der kunne være nyttige til lægefaglige formål, forsøger man at tage kontakt til mulige partnere, som kunne være villige til at tage del i eventyret. Innovative læger som Prof. Dr. Jünemann, Prof. Dr. Jonat og Dr. John var alle overbevist om projektets potentiale og villige til at bruge tid på at undersøge og udforske mobile enheder til mhealth. Det tager tid at finde sammen om en arbejdsmodel, især hvis projektet er henvist til at foregå i forskernes fritid. Her er hurtig udvikling af prototyper med foreløbige designs virkelig en hjælp til at opnå en fælles forståelse af det eventuelle produkt og dets funktioner. Faktisk er brugervenlighed altafgørende. Den næste udfordring er på produktionsniveau. Med de nuværende mobile enheder er spørgsmålet om platforme og styresystemer relevant for en producent, og det viste sig, at en webbaseret løsning, der er målrettet til flere platforme var svaret i vores tilfælde. Den viden, som vi opnåede fra denne proces, var igen frugtbar for afdelingen - andre fordele ved projektet inkluderer opdatering af kursusindholdet i vores studieordning samt involvering af studerende i produktionsprocesserne, hvor det var muligt. Udvikling på mange niveauer og med partnere, der delte inspirerende ideer med os, var alt i alt yderst interessant. DE Die eigene Herausforderung innerhalb des Projektumfangs von mhealth und den beteiligten Instituten zu definieren ist eine interessante Aufgabe. Um gleich mit dem schwierigen Teil zu beginnen: Eine medienproduzierende Einheit braucht Inhalte und ein bestimmtes Ziel. Aber die Idee von Interreg ist kein Ticketsystem; es geht um das Erkunden von Feldern und die Definition neuer Ziele bei gleichzeitiger Zusammenarbeit mit Partnern aus einem anderen Themengebiet in diesem Fall Medizin, sicherlich einem reichen Feld für das Sammeln, die Visualisierung und die Kommunikation von Patientendaten und medizinischem Wissen. Bei der Forschung erkennt man, dass telemedizinische Projekte wie Pilze hervorschießen, und man wird von der Idee, an diesem Innovationsprozess beteiligt zu sein, fasziniert. Bei der Suche, welche Eigenschaften und Dienste eines mobilen Geräts für medizinische Zwecke nützlich sein könnten, kontaktiert man mögliche Partner, die bereit sein könnten, sich an der Suche zu beteiligen. Innovative Ärzte wie Prof. Dr. Jünemann, Prof. Dr. Jonat und Dr. John waren vom Potenzial des Projekts gleichermaßen überzeugt und bereit, für die Erkundung und Erforschung mobiler Geräte für mhealth Zeit aufzuwenden. Es dauert Zeit, um auf einer Arbeitsebene zusammenzukommen, besonders wenn das Projekt für die Freizeit des Forschers reserviert ist. Hier können Rapid Prototyping-Verfahren mit Design-Prototypen wirklich helfen, um eine gemeinsame Vorstellung von dem möglichen Produkt und seinen Funktionen zu erhalten. Benutzerfreundlichkeit ist dabei von entscheidender Bedeutung. Die nächste Herausforderung liegt auf der Ebene der Herstellung. Bei den derzeitigen Mobilgeräten ist die Frage der Plattformen und des Betriebssystems für einen Hersteller relevant; eine webbasierte Plattform, die auf mehrere Plattformen abzielt, war in unserem Fall die Antwort. Die Erkenntnisse, die wir aus diesem Prozess gewonnen haben, waren wiederum fruchtbar für die Abteilung - zu weiteren Vorteilen des Projekts gehören die Aktualisierung von Kursinhalten im Lehrplan und, wo möglich, die Beteiligung von Studenten an Herstellungsprozessen. Insgesamt war die Entwicklung auf vielen Ebenen und mit vielen Partnern und mit anregenden Ideen, über die man sich austauschen konnte, in der Tat sehr interessant.

13 24 PERSPECTIVE EAL 25 By James Norwood UK Simple question: when was the last time you checked your smartphone? The answer is probably a time somewhere in the last ten to twenty minutes. These devices have become our hubs for information and certainly an integral part of our social lives. Attaching health information and services to such devices makes sense From delivering advice on exercises to perform post-operation to offering support and communication to women after they have been diagnosed with cervical cancer, information-based solutions, which are timely and ready at hand, have the potential to change the way in which hospitals interact and communicate with patients. That is not to say that there are not other uses for this technology, as the VITA project has shown that the devices themselves can act as a bridge for communication with patients who are incapacitated after surgery. Motivation-based solutions mapped out by smart positional data and push mechanisms, as with the Fit Cook app, show that there are a host of solutions for improving health on many different social levels. Indeed, it is the ShareCare platform (developed by students from EAL) that utilised our basic need to communicate, enabling patients with illnesses to share their hopes and fears with others just like them in the safety of a hospital environment. We are moving into a future in which health information is not only delivered via hospitals but also generated by the patients themselves (quantified self). Wearable devices that are able to monitor all aspects of our physical and social well-being are becoming increasingly affordable and accessible. However, questions still remain as to how and who will be responsible for interpreting this data, but what is certain is that quantified self-movement has the potential to radically alter the way we interact and interface with our health care systems. As an academy, we continue to build upon the knowledge, skills and success of the Appliedhealth project, exploring new opportunities in the fields of self-monitoring and information-based health solutions of the future.

14 26 27 DK Det enkle spørgsmål er: hvornår kiggede du sidst på din smartphone? Svaret er sandsynligvis et tidspunkt indenfor de seneste ti til tyve minutter. Disse enheder er blevet informationscentre og helt klart en fast bestanddel af vores sociale liv. At forbinde sundhedsoplysninger og sundhedstjenester med disse enheder giver mening. Fra levering af råd om øvelser efter en operation til tilbud om support og kommunikation til kvinder, når de har fået en diagnose om halskræft, har informationsbaserede rettidige løsninger, som er lige ved hånden, potentiale til at ændre den måde, som sygehusene interagerer og kommunikerer med patienterne. Det betyder ikke, at der ikke findes andre måde at bruge teknologien på, hvilket VITA-projektet viste: enhederne kan i sig selv bygge en kommunikationsbro til patienter, der er svækkede efter en operation. Motivationsbaserede løsninger, som er fastlagt ved hjælp af smarte positionsdata og push-mekanismer, som med Fit Cook-app en, viser, at der er en række løsninger til forbedring af sundheden på mange forskellige sociale niveauer. Det er faktisk ShareCare-platformen (udviklet af studerende hos EAL), som udnytter vores grundlæggende behov for at kommunikere, der giver patienter med sygdomme mulighed for at dele deres håb og frygt sammen med andre, nøjagtig som de patienter, der befinder sig i sikre rammer på et sygehus. Vi er på vej ind i en fremtid, hvor sundhedsoplysninger ikke kun leveres via sygehusene, men også genereres af patienterne selv ( Quantified self ). Bærbare enheder, som kan holde øje med alle aspekter i vores fysiske og sociale velbefindende, bliver hele tiden billigere og mere tilgængelige. Der er dog stadig spørgsmål om hvordan og hvem, der er ansvarlig for fortolkning af disse data, men det er sikkert, at quantified self-bevægelsen har potentiale til radikalt at ændre den måde, som vi interagerer og kommunikerer med vores sundhedssystemer. Som akademi vil vi fortsat bygge oven på den viden, de evner og den succes, som Appliedhealth-projektet har haft, og i den forbindelse vil vi undersøge nye muligheder indenfor egen overvågning og informationsbaserede sundhedsløsninger for fremtiden. DE Einfache Frage: Wann haben Sie das letzte Mal nach Nachrichten in Ihrem Smartphone gesehen? Die Antwort ist vermutlich eine Zeit der letzten zehn bis zwanzig Minuten. Diese Geräte sind zu Schaltstellen für unsere Informationen geworden und stellen sicher einen integralen Bestandteil unseres gesellschaftlichen Lebens dar. Gesundheitsinformationen und -dienste mit solchen Geräten zu verknüpfen macht Sinn. Von der Bereitstellung von Rat für Übungen, die nach einer Operation durchzuführen sind, bis zum Angebot von Unterstützung und Kommunikation für Frauen, nachdem bei ihnen Gebärmutterhalskrebs diagnostiziert wurde, haben informationsbasierte Lösungen, die zeitnah und griffbereit sind, das Potenzial, die Art und Weise zu ändern, in der Krankenhäuser mit ihren Patienten interagieren und kommunizieren. Damit soll nicht gesagt sein, dass es keine anderen Verwendungen für diese Technologie gibt, wie das VITA-Projekt gezeigt hat, dass die Geräte selbst als Brücke für die Kommunikation mit Patienten dienen können, die nach einer Operation behindert sind. Motivationsbasierte Lösungen, ausgearbeitet auf Basis smarter Positionsdaten und Push-Mechanismen, wie bei der Fit Cook -App., zeigen, dass es eine ganze Reihe von Lösungen gibt, um die Gesundheit auf vielen verschiedenen sozialen Ebenen zu verbessern. Tatsächlich ist es die ShareCare-Plattform (entwickelt von Studenten der EAL), die unser Grundbedürfnis nach Kommunikation nutzt, um Patienten mit Krankheiten in die Lage zu versetzen, sich mit anderen in gleicher Situation in der sicheren Umgebung eines Krankenhauses über ihre Hoffnungen und Ängste auszutauschen. Wir bewegen uns in eine Zukunft, in der Gesundheitsinformationen nicht nur über Krankenhäuser geliefert werden, sondern von den Patienten selbst ( Quantified Self ). Tragbare Geräte, die alle Aspekte unseres körperlichen und sozialen Wohlbefindens überwachen können, werden immer erschwinglicher und leichter zugänglich. Allerdings bleibt die Frage, wer für die Interpretation solcher Daten verantwortlich sein wird und wie; sicher aber ist, dass die Quantified Self-Bewegung das Potenzial hat, die Art und Weise, in der wir mit unseren Gesundheitsdiensten interagieren und kommunizieren, radikal zu ändern. Als Akademie bauen wir weiterhin auf dem Wissen, den Fähigkeiten und den Erfolgen des Appliedhealth-Projekts auf, erkunden neue Chancen auf dem Gebiet der Selbstüberwachung und informationsbasierter Gesundheitslösungen der Zukunft.

15 28 29 APP DEVELOPMENT PROCESS INSIGHTS App development comprises several stages. Before starting the dedicated development stage, it is necessary to perform formative user research, which can be done in a number of ways. The purpose of the user research is to examine potential user needs and wishes for functionality. When user research is done, the early development stage can start off with several visualisation techniques such as bodystorming, sketching or prototyping with electronics. The purpose of this is to share a vision of how the app should look, feel and perform before launching into the technical implementation. The result is a number of different prototypes that can be tested by representatives of the potential users. At an early stage, there are concepts of the target, and these concepts cumulate in an interface design. Prototyping tools, such as Balsamiq, help to create click dummies. This is very helpful in envisaging the idea of the app to customers and, if necessary, developers. The mock-up delivers a good discussion base and clarifies what functions are or should be available. On a purely graphical level, without functionality it is harder to anticipate the whole user scenario. Depending on the needed functionality and device sensors, target platform for the app to run on, network connection on the user s device plus data storage scope, a decision between a native app and a web app has to be made. Multidevice platforms, sizes and formats mean a lot of adaptation. Creating specialised single solutions, such as an app for iphone5 and ipad Mini, exclude many other users and mean redeveloping the project for the other platforms or device sizes. HTML5-based web apps run on any device if designed responsively, and they even have an acceptable appearance on many smartphones. With some software, it is possible to integrate functionality of native apps and compile formats for any platform (ios, Windows, Android, Blackberry, Bada, etc.). This workflow seems to bear rich options at the moment, provided we do not depend only on native solutions. The integration into hospital IT infrastructure can be demanding and should be analyzed clearly before starting the development. Sometimes, the better option is to set up a separate server, simulate and develop the required administration tool and regard it as part of the prototyping, which means real data integration might have to wait for a total relaunch.

16 30 31 PROJECTS

17 32 33 PROJECTS OUH TITLE Wayfinder App MADE BY Woerk COLLABORATION LEAN & Innovation OUH Finding your way around the numerous entrances and departments of Odense University Hospital and Svendborg Hospital can be a complicated affair. One of the effects of this is that patients are often late for appointments and sometimes even fail to find the correct hospital department at all, which negatively impact both hospital operations and the budget. The OUH Wayfinder app solves this problem by helping patients and staff navigate their way around Odense University Hospital and Svendborg Hospital. With the Wayfinder app, users are able to look up specific departments/entrances along with the hospitals addresses. Based on one s current location, Wayfinder is able to provide the user with the fastest route

18 34 35 to his or her destination by displaying the route on an overview map of the hospital s campus. Another incredibly smart and useful feature of this app is the Wayfinder QR scanner. Appointment letters that have been sent out by the hospitals now feature a QR code. By scanning this code, Wayfinder is able to provide patients with the exact appointment address. Wayfinder is also able to keep a history of a patient s most recent hospital visits as an additional measure to ensure that he or she is able to locate the correct hospital address. The app is available as a free download on both ios and Android platforms.

19 36 PROJECTS UKSH TITLE Interactive Medical Education Library MADE BY Felix Prell COLLABORATION K.-P. Jünemann, D. Osmonov, D. Melchior Have you ever had surgery? Do you remember the pre-op info flyer you were given to read? Do you remember signing it? Well, maybe you do, and maybe you don t, but if you are like 90 percent of all patients, chances are you don t remember much of the content. Why is this? It is because normal medical education is often dull and difficult to comprehend. And why is that? Because, ultimately, the people who really have to be happy with these educational sheets are the lawyers, which is also why you are not just given these sheets to read but are required to sign them. What you sign is that you have read the information, understand absolutely everything and are aware that there are about a trillion possible side effects and that you could be horribly disfigured and/or infected with some weird disease from contaminated blood transfusions. Oh, and did we mention that you might die? No? Ok, here goes: you might die! Please sign on the dotted line. This kind of prioritization is also reflected

20 38 39 in the length of the educational texts. In many cases, the list of possible side effects and adverse events is longer than everything else combined. While soothing to the judicial profession, this situation is cruel toward patients, so we set out to change it. For a number of medical procedures in the field of urology, we have developed interactive medical education titles, preferably to be viewed on tablets. They feature texts that are easy to understand by nonprofessionals along with intelligible illustrations, graphics, videos and animations that demonstrate principles and foster understanding. Patients may freely choose the order in which they want to explore the program s content, such as background information, before and after, the procedure itself, side effects and so forth. They receive visual feedback about which parts they have already completed and are given the option to answer questions and perform tasks that show which parts they have understood and which are still problematic. The program then adapts and reacts accordingly. This process is tremendously helpful and also makes the consultation with the physician much more effective. The result is patients who have gained true knowledge of their situation and take interest in and responsibility for their own health.

21 40 TITLE Uro-App MADE BY Felix Prell COLLABORATION K.-P. Jünemann, D. Osmonov, C.M. Naumann TITLE Wayfinder MADE BY Name lastname, Name Lastname, Name COLLABORATION K.-P. Jünemann, D. Osmonov, D. Melchior When patients go to a university hospital or major medical centre, they are often confused, perplexed, unsure, unclear, bewildered and/or disoriented. They are lost on a number of different levels. They are lost physically because the campus is often huge, buildings are scattered around seemingly without a plan, the internal layout is chaotic and overall there does not seem to be any kind of unifying principle or organisational structure. Second, patients are lost procedurally because they don t know what happens when, where, why and in what order. They don t know where they need to go, what to bring along or what to give to whom. Organisational structures in big public organisations can be even more chaotic and messy than their physical counterparts. Third, patients are lost medically. Medical information is given to them too late, and it is often incomprehensible, too general and almost never adapted to their own personal situation or their individual needs and preferences. The UroApp aims at rectifying this situation by addressing the medically lost part in a comprehensive and comprehensible manner. Patients are given access to a number of informational sources that we developed specifically for this purpose. A simple menu grants patients access to the information they seek by allowing them to first select the area of concern graphically. Then they choose from a list of respective conditions, background information and treatment options. Once a selection is made, the app presents different kinds of specifically developed information and educational media. For example, a patient might want information on prostate cancer. He will therefore select the prostate symbol on the main screen, which will result in a list of prostate-specific topics, such as BPH (benign prostatic hyperplasia), digital rectal exams, prostate cancer (prostate carcinoma), prostate cancer screening, prostatitis (prostate inflammation), PSA (prostate specific antigen) levels, prostatectomy (removal of the prostate) and so forth. The patient will then select prostate cancer, and the app will present available media in this case, a four-page informational flyer, a 240-page book, and a five-part video series (each video being about four to seven minutes long). The videos are available in different languages and with various subtitles.

22 42 43 TITLE mychild MADE BY Felix Prell COLLABORATION D. Osmonov and D. Melchior TITLE Wayfinder MADE BY Name lastname, Name Lastname, Name COLLABORATION K.-P. Jünemann, D. Osmonov, D. Melchior For most new parents, the experience of raising a child can be quite overwhelming. New parents are often unsure about any and everything concerning their progeny. Sometimes, it is right to worry, and other times they worry for nothing. And still other times, mothers and fathers have no clue that something is wrong and that they need to act quickly. Respective questions are aplenty and ubiquitous. My daughter is not talking yet. Is that normal? My son is not walking yet. Should I be concerned? Our child weighs twenty-four pounds. Is that too little? Is it too much? My daughter can t figure out that the round peg does not fit into the triangular form. Is her mental development challenged? My son constantly bumps into things. Should we worry? My little one is now six months old. Which checkups does she need? Does she need any inoculations? Should I stop breastfeeding now? These and many more questions have parents feeling worried and concerned 24/7, and they always fear that they might have forgotten, overlooked or ignored some important aspect. The mychild child development app acts as a counsellor and memory bank for these concerns. It regularly asks parents to enter current information about their child (e.g., height, weight and cognitive and physical development and abilities) as well as reminds them about necessary checkups and inoculations. The app then correlates the data entered. If discrepancies are found between the way the child is developing and the development considered normal for a child of that age, the app informs the parents and reminds them to seek out a specialised doctor who can decide if corrective action needs to be taken. This app takes a huge burden off parents shoulders as they can finally stop worrying about whether their child is developing normally. It also helps parents and doctors alike, as it concentrates all relevant information about the child in one place that is easily accessible and always available: a smartphone.

23 44 45 TITLE myfirstclinic: Patient Information and Guidance Services for Kids MADE BY Felix Prell COLLABORATION D. Osmonov, D. Melchior, C.M. Naumann Taking a child to the hospital can be challenging as the unknown surroundings can often intimidate or scare the child. Therefore, parents and doctors must not only deal with the sickness but also with these terrors. Before the treatment can start, these fears must be overcome and the child s trust must be won, a difficult and time-consuming task, especially when immediate care should be given. As such, it is far better to deal with these problems and create trust and a positive attitude before the child s arrival to the hospital. This task can be effectively performed by using myfirstclinic, an interactive electronic app that introduces the child to the world of the clinic and creates a positive state of mind toward it. It makes contact starting with the concrete situation at home. It is not viewed as a machine but presents itself as a friendly animal or playful robot, a friend who takes the child s hand, comes along with it, shows and explains the unknown world and introduces the child to new people. When the child arrives at the hospital, this friend welcomes him or her in the form of a three-dimensional original present in the lobby, expecting the young patient and greeting him or her by name. The parents can take a photo for memory, which will reinforce the child s positive feelings about the clinic. This animal or robot friend can explain the symptoms of the illness, the treatment, the way through the clinic, and all the necessary activities. Thus the child will be familiar with this new world, fear will vanish and confidence and trust can be built. The language is adapted to children, just like the pictures and animation. The program can be individualised, including the corporate identity of the clinic and the names, voices and faces of the doctors and nurses. This app takes a burden off parents and doctors shoulders, provides easier access to the children and allows for trust and willingness to take an active part in the treatment. Lastly, it saves trouble, time and money.

24 46 47 PROJECTS FH KIEL TITLE Speak freely MADE BY Malte Boedeker, FH Kiel COLLABORATION FH Kiel - UKSH Do you feel slightly or moderately uncomfortable when having to speak in public? This is a very common phenomenon. Many people, of any age or profession, suffer from glossophobia (i.e., fear of public speaking), even actors and teachers. This fear can sometimes become quite an obstacle in a person s life (e.g., when people avoid taking exams). The purpose of Speak Freely is to explain the physiological functions of fear and training to reduce tension before public speeches. One can do many of the tasks from virtually anywhere for example, while sitting on a bus because they are audio files that require only one s imagination. A special feature of Speak Freely is an individualised training plan, which changes based on how much time a person has before the speech is scheduled. Long-term training units with a focus on physical relaxation techniques such as yoga or muscle relaxation are given when there is more time for training. Additional training exercises include confrontations such as standing up in a public place and simply bearing the situation to experience that nothing will happen. Shortly before the speech, one also gets relaxation tips. It should be mentioned that serious social phobias need treatment by a psychologist. This app is not meant to substitute for treatment of this kind but rather to assist and make life easier for millions of people who suffer from the burden of speaking in public or in front of a crowd. The hybrid web app can be viewed via smartphone browser or installed on any mobile operating system. This e-learning and training app for people with particular stress problems was created by Malte Boedeker from FH Kiel.