Telemonitoring efforts have been spent since some time for managing diseases and administering treatments in outpatients with the aim of enforcing a tighter control on the therapy. Those systems most often address the management of chronic diseases on the basis that they help in delaying the onset of their complications and reduce hospitalization episodes thus saving any related costs. Until recently remote monitoring for outpatients usually entailed sending a limited amount of information daily, or even less frequently, through a fixed station such as a PC, using landline connections and according to the patient convenience.
Literature has shown that the effectiveness of telemonitoring greatly increases with systems always available to the patient, which resulted in a poor exploitation of those systems due to the opposite paradigm they privileged.
Today’s quality of network connections, combined with the current performance of smartphones, allow instead the design of a new class of systems which seems to provide a viable and promising solution. Besides the improved comfort for the patient due to the mobility, the possibility of interfacing smartphones with external devices opens up the possibility of an ubiquitous and automatic transmission of signals in real time which may help also for monitoring clinical trials.
The laboratory of Biomedical Informatics is particularly active in the telemonitoring area involving smartphones and tablets both as a provider of the enabling infrastructure and as a system integrator delivering the custom solutions. To this aim we have developed a modular two-way synchronization infrastructure which is particularly valuable for mobile devices since it is able to buffer data in poor network coverage conditions, thus preventing any loss of data .
The infrastructure has been used as a basis for enabling the remote monitoring of an Artificial Pancreas implemented on a wearable device using the Android Operating System . Besides guaranteeing patient safety this system proved to be particularly useful for collecting data into a central database in order to delegate the extensive computations needed for tuning and personalizing the insulin controlling algorithms to a server.
Synchronization can also be exploited for implementing generic Points of Care, such as the one we designed to support patients affected by nephropathy. For those patients we developed a system directly linked with a scale and a blood pressure monitor which allowed them to send daily measurements to the clinic . A present efforts sees instead the implementation of a Point of Care supporting remote cardiotocographical consultations for pregnant women. In that case a smartphone has been interfaced with a device for capturing cardiac signals and allows women at risk to autonomously acquire data and send them to their treating gynecologists for getting frequent consultations.
Finally, in order to complement the transmission of plain signals with contextual information, we also implemented a system running on tablets and useful to download custom questionnaires on demand from a site. That system allows patients to fill in questionnaires as many times as needed and synchronize their answers with a remote site for a prompt perusal by the clinicians .
The above mentioned examples only represent some possible exploitations of the mobile networked technology applied to health care, since the number of applications is virtually countless.
Artificial Pancreas, Diabetes and Chronic Diseases Treatment,
Cardiotochography, Clinical Investigations.
People working on this topic:
Ignazio Secci, Stefania Scarpellini, Germana Ginardi
Supervisors: Giordano Lanzola
Prof. Giovanni Magenes, Laboratory of Bioengineering, University of Pavia, Pavia, Italy.
Prof. Maria Gabriella Signorini, Politecnico di Milano, Milano, Italy.
Prof. Lalo Magni, Dept. of Civil Engineering and Architecture,
University of Pavia, Pavia, Italy.
Funny ; Chronic Disease Monitoring ; AP Monitoring Trial ; GQuest 
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