eHealth: Remote monitoring of biomedical parameters
How do you rate this example?
- What’s the solution?
- What makes it smart?
- How is the solution implemented?
- In what local context has it been applied?
- Who was behind the implementation?
- What was the local journey?
- What have been the main outputs & results?
- What does it bring the village/community?
- What’s needed
- What to do…
- and not to do.
Where to find out more?
Region or village : Sabugueiro, Portugal
Country : Portugal
Population : 478
Contact person :
Last updated : 16/10/20
What’s the solution?
This solution allows remote monitoring of parameters such as weight, blood pressure, heart rate, blood glucose, oximetry and body temperature. These parameters are of the utmost importance, since they are directly related to pathologies with a great prevalence in Portugal, and are responsible for high rates of mortality and morbidity and, therefore, represent a relevant economic cost for the National Health System.
The eHealth system allows the early diagnosis and prevention of risk situations, as well as a more efficient management of care provision, in particular for those suffering from chronic illnesses, and an improvement in the response capacity of health units.
This particular version of eHealth solution – applied in the Portuguese village of Sabugueiro - makes use of a recent technology developed by a private national company, based in the Institute Pedro Nunes (IPN) Incubator - Association for the Development of Incubation Activities for Ideas and Businesses (a private, non-profit institution created in 2002 on the initiative of University of Coimbra.
The equipment consists of a kit including a weighing scale, a digital blood pressure monitor (sphygmomanometer) with integrated blood glucose meter, and a tablet computer.
The user – either autonomously or with support from a carer - performs the measurements at home, and the data is transmitted via Bluetooth to the tablet computer where, after validation, it is sent via internet in an encrypted and secure mode using the integrated 3G module to a specific server (web portal), where is stored and made available for consultation to duly authorised health professionals in real-time. The historical data is also available to the authorised professionals.
What makes it smart?
The system anticipates future trends and needs that citizens will increasingly have, in order to allow a better quality of life in the inland areas and of rural communities.
The solution is smart because it allows for the remote monitoring – based on digital and technological innovation of biomedical parameters (blood pressure, heart rate, blood glucose, oximetry, body temperature and others) of its users, who can take the measurements without having to go to the Health Centre.
It serves both to facilitate the community’s access to personalised and quality healthcare and the early detection of health concerns - through daily changes in the measured parameters – including changes that may endanger the user’s health in the future.
The solution supports more effective and cost-efficient interventions. Because the health professionals have continuous information on the user's health status, in cases where it is necessary to resort to differentiated health care, it makes the response of medical care faster and more appropriate. It is even possible to make daily adjustments of provided therapies, allowing for better control of pathologies.
The system also provides the ability to contact the user directly with guidance or even direct instructions to carry out a therapeutic intervention on the spot with medication that the user – or their carer - may have available at home. This reduces pressures and costs on overstretched health and care services.
The solution may have multiple users, and, as such, it is considered to be an ideal solution for retirement homes and assisted living.
How is the solution implemented?
- The implementation of an eHealth solution such as the one presented here is not about villages or rural communities developing their own new technical solutions. It is about finding the right partners and suppliers who can. The following are the key principles to follow and respect when developing such relationships:
- Openness and ability to apprehend the importance of exploring new ideas for the purpose of social and economic development.
- Identification of the specific needs and challenges faced by the rural community.
- Identification and engagement of stakeholders, based on the construction of a strategic partnership, in which the partners were able to commit and to contribute in a significant way to the project’s design and implementation (e.g., expert knowledge, financial availability).
- Find the appropriate solutions and suppliers to answer the identified needs and challenges. The approach can build on already available technology to adapt and apply it in the specific rural setting according the needs of users, carers and health service providers.
- Shared understanding of the identified needs and challenges and solution identification.
- Delivery of the digital solution, and contribution to make the necessary adjustments in order to facilitate its use (e.g., raising digital awareness and capacity building).
- Monitor access and take up of the digital solution.
- Provision of technical support and ongoing training mainly, from the health care entity to the end-users.
- Consolidation of the use of the digital solution and recognition of the positive results.
In what local context has it been applied?
Sabugueiro is a small mountainous village located in inland Portugal (Region Centro). It is one of the highest villages in the country (1,120 m above sea level) and quite The village has seen its population decrease by around 40% since 1970 and the municipality has a population density of 10.3 inhabitants/km² (2011)
The village is characterised by population ageing - 45% of residents are over 65 years old (2011) - and youth out-migration, low qualifications and low incomes, erosion of public services, inability to attract new residents due to the lack of jobs, information exclusion (very low level of digital literacy), lack of dynamism of the associative movement and harsh weather conditions.
Key characteristics that drove the need to test the application of an eHealth solution were:
• The village also has no medical facility.
• It is relatively isolated from the main urban centres of the Region (10 km from Seia - the seat of the municipality, and 75 km from Guarda - capital of the district, where the main services are located).
• There is a lack of public transport to make the connection between the village and the nearest city (Seia), making the population dependent on their own vehicle, taxis or ambulance to get to the Health Centre.
• The heavily ageing local population, which has difficulties to access healthcare for the reasons listed above and which, in addition, suffer risks of information exclusion and social isolation
In terms of social infrastructure, Sabugueiro only has a small elementary school, a community oven, a sport pavilion, an ethnographic museum and the Sabugueiro Charity Association - which has been developing social work through a series of activities including a retirement home, day care centre, home support, medical care and a pharmacy service.
Who was behind the implementation?
A partnership between the main local entities which work with and care for end users:
• the Municipality of Seia
• the Health Centres of Seia and Guarda
• the Sabugueiro Charity Association
• the Parish Council of Sabugueiro
What was the local journey?
This solution was made available to individuals residing in Sabugueiro, selected with the support of the Seia’s Health Centre, based on their medical history (e.g., incidence of chronic diseases, namely, hypertension, obesity and diabetes). In terms of key steps taken and challenges faced we highlight that:
• Engineers had to adapt the initially selected equipment to the needs of older end-users. In fact, only after two attempts was the final version reached (e.g. alteration in the buttons’ size - which were very small -, and decrease of the amount of text to be more intuitive).
• To help end users understand this new system, training was provided to employees of local private social security institutions and other entities involved in the project. These then transferred the ‘hands-on’ training to end users (a kind of ‘training the trainers’ process). Users were informed how to use the equipment, about the recommended number of measurements to be carried out and the values to be fulfilled according to their pathologies.
• The low familiarity of users with the concept of telemedicine was a big challenge, as well as the low access to internet at home (only about 40%), the high age structure (average age is 64 years old) and the low level of education (70% has only primary education – 4 years). This limited the autonomous use of the solution, which was overcome by engagement with care providers or professionals from the Charity Association. Of the total number of users, about half is monitored with the support of their caregivers, and the other half carry out the measurements autonomously.
• It is also worth mentioning the bureaucratic obstacles (legal and ethical). Given the innovative features of the solution and the rules inherent to the Regulation for the Protection of Personal data, the implementation of the smart solution had to be submitted to the approval of the National Data Protection and of the Health Ethics Committees. The approval process took about eight months. This issue was solved with the encryption of the data transmitted for each user.
What have been the main outputs & results?
- Significant adherence to the smart solution, resulting in a closer monitoring of the elderly health parameters.
- Ability to use the equipment and app, despite barriers and experiencing some technical difficulties. Greater accessibility and coverage of health care to the rural community (particularly, elderly with health issues).
- Better communication between users / patients and healthcare professionals (satisfaction of users with the feedback provided by the health professionals).
- Expenditure reduction on health care: in the short-term through the immediate decrease of the costs related with transport to the health centre; and in the long-term through the early detection of situations that may endanger the user’s health. With the early detection of these situations, and having the ability to contact the user, it is possible provide guidance and, sometimes, carry out a therapeutic intervention on the spot with medication that the user may have available at home.
- Additionally, taking into account that health professionals have continuous information on the user's health status, in case it is necessary to resort to differentiated health care, it makes the response of medical care faster and more appropriate.
- Increase of the users’ health status, motivating the continued use of the smart solution. Users understand better that a correct nutrition and improved daily habits (e.g., physical activity) can positively influence their health status and are able to play an active role in their own treatment.
- Reduction of carbon emissions given the reduction of the use of vehicles to transport people with healthcare needs to the nearest Health Centre.
- In sum, the smart solution allowed for, not only the reduction of expenditure through the decreased number of exacerbations and hospital admissions, but also the improvement of the health status, with the patients having a better understanding of their health issues and how is it possible to manage.
What does it bring the village/community?
- This solution was considered beneficial and of great utility, particularly to the people that don’t have easy access to healthcare.
- This solution also allowed for an improvement of the rural community quality of life:
- Decreased social isolation and loneliness. The use of the tablets has been extended to communicate, e.g., with family members who are distant (many emigrated).
- Increased level of digital literacy. Many elderly people, although lacking experience with Information technologies and often with initial resistance to engaging with the digital world, learned to use the digital equipment (in this case, tablets) and took the opportunity to stay connected and informed.
- These observations provide preliminary evidence that older individuals can effectively engage with and benefit from these type of smart solutions.
- The benefits and limitations of telemedicine initiatives are not yet fully understood . Nonetheless, it is considered that an adequate management of health parameters and, in this way, a reduction of risk factors is of major importance in order to reduce the local, regional and national health system expenditure, support people to live longer in their own homes and, more significantly, to reduce morbidity and premature mortality.
The smart solution was implemented with the full support of the private company that created it. The same company also provided training to the professionals directly involved in supervising and using the solution (health professionals: doctors, medical auxiliaries and nurses; professionals/auxiliary services of the Sabugueiro Charity Association; and employees of the City Council). The aim of this training was also to make the trainees able to transfer all the needed knowledge and know-how in their own institutions and to the end-users and care givers (concept of "training the trainers").
Thus, the implementation does not need a specific knowledge regarding technologies, but requires a strong human capital base.
The implementation of the smart solution needed the availability of fast fibre connectivity.
What to do…
- Establish partnerships with key local entities, keep them involved in all stages of the project, and shape the technical solutions in a way that respond to the communities’ needs and expectations (technology at the service of the community).
- Identify and engage partners operating in the project’s areas of intervention that are sensible to the specificities of the rural territories and concerned about all the aspects of rural development.
- Select villages and communities with capacity to adapt to change and, most importantly, that demonstrate interest in the project and understand the advantages. Only this way, it will be possible to implement the project / strategy within the desired bottom-up approach.
- Establish long-lasting and high-quality projects and partnerships with a strong governance system, to ensure the production of the expected results and their lasting nature.
- Ensure an appropriate financial support to safeguard the project’s sustainability in the long term.
- Conduct a study that tries to objectively understand how this type of project is cost-effective and to what extent it has an impact on the users’ health status (e.g., reduction in complications, hospitalisations and expenses with health care).
and not to do
- Don’t over-invest in a new technology before getting to know it well and ensuring it can really be adapted to local users’ needs.