Feasibility and usability of an ontology-based mobile intervention for patients with hypertension.

BACKGROUND: Lifestyle changes and the adoption of healthy behaviours are well established recommendations for the management of hypertension-a risk factor for cardiovascular and kidney disease. Mobile health interventions offer unique advantages and novel approaches to helping individuals make and maintain such behaviour changes; however, current interventions often lack theoretical and scientific grounding. OBJECTIVE: The goal of this study is to effectively model the knowledge, concepts and relationships relevant to the management of a chronic illness like hypertension, and to implement this knowledge model within a mobile self-management application that can be used by patients. METHODS: A behaviour modification approach based on COM-B (capability, opportunity, motivation, behaviour) Model and the associated Behaviour Change Wheel was developed. An ontology-based knowledge model was implemented to formally conceptualise relevant knowledge in hypertension clinical practice guidelines, behaviour change models and associated behaviour change strategies. A hypertension management decision support framework was designed and implemented as a proof-of-concept mobile phone application (EmpowerBP) using the aforementioned model. The usability of this pilot application was tested using think-aloud protocol by eight individuals with hypertension while performing predefined tasks. Thematic analysis with inductive thematic coding was performed to identify specific feedback and areas for improvement. RESULTS: The most common positive feedback included participants finding application resources interesting or helpful and liking the user interface. The most common negative feedback was finding the included salt calculator confusing or laborious to use and finding the profile creation questionnaire too long. The derived themes were: features, profile creation, resources, scenario, usability, user interface. CONCLUSIONS: The ontology knowledge model formalises variables, properties, and relationships such that they can be used for problem solving. By integrating and computerising complex knowledge from clinical practice guidelines, behaviour change theories, and associated behaviour change strategies, it is possible to model existing information about the management of hypertension as an ontology. This proof-of-concept application creates clinical and behavioural profiles of a user to provide them with personalised management strategies, rooted in established behaviour change theory, that will engage and empower them to manage their condition. Given the nature of ontological models, this approach can be easily modified to address a variety of chronic illnesses.

Optimizing primary care management of atrial fibrillation: The rationale and methods of the Integrated Management Program Advancing Community Treatment of Atrial Fibrillation (IMPACT-AF) study.

The Integrated Management Program Advancing Community Treatment of Atrial Fibrillation (IMPACT-AF) is an investigator designed, prospective, randomized, un-blinded, cluster design clinical trial, conducted in the primary care setting of Nova Scotia, Canada. Its aim is to evaluate whether an electronic Clinical Decision Support System (CDSS) designed to assist both practitioners and patients with evidence-based management strategies for Atrial Fibrillation (AF) can improve process of care and outcomes in a cost-efficient manner as compared to usual AF care. At least 200 primary care providers are being recruited and randomized at the level of the practice to control (usual care) or intervention (eligible to access to CDSS) cohorts. Over 1,000 patients of participating providers with confirmed AF will be managed per their provider's respective assignment. The targeted primary clinical outcome is a reduction in the composite of unplanned cardiovascular (CV) or major bleeding hospitalizations and AF-related emergency department visits. Secondary clinical outcomes, process of care, patient and provider satisfaction as well as economic costs at the system and patient levels are being examined. The trial is anticipated to report in 2018.

A Mobile and Intelligent Patient Diary for Chronic Disease Self-Management.

By involving patients in their own long-term care, patient self-management approaches aim to increase self-sufficiency and reduce healthcare costs. For example, electronic patient diaries enable patients to collect health data autonomously, increasing self-reliance and reducing strain on health professionals. By deploying patient diaries on mobile platforms, health data collection can occur at any time and place, increasing the mobility of chronic patients who typically need to enter health data frequently. Importantly, an opportunity also arises for mobile clinical decision support, where health feedback is directly issued to patients without relying on connectivity or remote servers. Regardless of the specific self-management strategy, patient and healthcare provider adoption are crucial. Tailoring the system towards the particular patient and toward institution-specific clinical pathways is essential to increasing acceptance. In this paper we discuss a mobile patient diary realizing both the opportunities and challenges of mobile deployment.

Usability evaluation of family physicians' interaction with the Comorbidity Ontological Modeling and ExecuTion System (COMET).

OBJECTIVE: To assess how well the COMET system meets the functional goals and usability needs of family physicians (FP) for the management of patients who have comorbid chronic heart failure (CHF) and atrial fibrillation (AF). DESIGN: Nonexperimental post-interaction Think Aloud Sessions and survey involving Likert scale questionnaires. PARTICIPANTS: Licensed Family Physicians in Nova Scotia. INTERVENTION: A clinical decision support tool called "COMET - Co-morbidity Ontological Modeling & ExecuTion". COMET's main purpose is to provide evidence-based recommendations for the management of patients with co-morbid CHF-AF in a family practice setting. RESULTS: Our study suggested that although the participant family physicians are potential users of the clinical decision support software like COMET, the most common usability problems encountered are related to inadequate information content, navigation, and time and effort for data entry. We recommend that a field usability testing of a CDSS using think aloud protocols in conjunction with surveys is an effective method to uncover usability problems.

Ontology-based modeling of clinical practice guidelines: a clinical decision support system for breast cancer follow-up interventions at primary care settings.

Breast cancer follow-up care can be provided by family physicians after specialists complete the primary treatment. Cancer Care Nova Scotia has developed a breast cancer follow-up Clinical Practice Guideline (CPG) targeting family physicians. In this paper we present a project to computerize and deploy the said CPG in a Breast Cancer Follow-up Decision Support System (BCF-DSS) for use by family physicians in a primary care setting. We present a semantic web approach to model the CPG knowledge and employ a logic-based proof engine to execute the CPG in order to infer patient-specific recommendations. We present the three stages of the development of BCF-DSS--i.e., (a) Computerization of the paper-based CPG for Breast Cancer follow-up; (b) Development of three ontologies--i.e., the Breast Cancer Ontology, the CPG ontology based on the Guideline Element Model (GEM) and a Patient Ontology; and (c) Execution of the Breast Cancer follow-up CPG through a logic-based CPG execution engine.