The Smartphone as a Tool to Improve Cardiac Rehabilitation

Background: M-Health can improve healthcare in developed economies by minimizing unnecessary visits to a hospital. New application scenarios have emerged recently, where healthcare professionals can access patient records by connecting to the Hospital Information System (HIS) anywhere and anytime. In recent years, a large number of m-health applications have emerged improving the ubiquity of healthcare providers. Additionally, they also allow for patient empowerment improving individual health and preventive medicine. Objective: To develop a mobile system to improve cardiac rehabilitation in chronic heart disease patients, allowing them to participate in the development and maintenance of an active health. Methods: This system consists of a portable Bluetooth device to acquire ECG and SpO2 data, an Android Smartphone application, and an intelligent central server. The acquisition device sends data to the Smartphone using Bluetooth Health Device Profile (HDP) and following the Continua Health Alliance guidelines, that ensure interoperability between devices. The Smartphone application acts as a gateway between the acquisition device and the server, sending data through HTTPS using 3G or WI-FI connection, and provides feedback to the patient. The central server stores and analyzes data to extract statistical parameters, predicting risk events and sending alarms to clinicians automatically. Two types of users coexist in the system: the patients prescribed with exercise for cardiac rehabilitation, and their clinicians. When a patient is going to do his/her rehabilitation exercises, (s)he logs into the Smartphone application, connects it to the acquisition device, and records data in resting state for several minutes. Then, the patient carries out the rehabilitation exercises and monitors her constants again when finished. After that, the patient fills in a questionnaire to collect subjective data. Once finished, the Smartphone sends the questionnaire and the acquired data to the central server, where are stored in the database and analyzed. Then, clinicians can consult the evolution of the patient along the treatment, as well as statistical data through a web application. Results: Clinicians can perform a complete monitoring of the patients’ data and their opinion, vital for preventing treatment neglect. Additionally, the system stores data in the Electronic Health Record (EHR), allowing clinicians to perform prospective studies. Our system satisfies semantic interoperability to ensure understanding of the exchanged information by the different applications and services in the system. All data are encrypted to fulfill the Spanish Data Protection Act. The system is currently being evaluated by the Spanish Federation of Heart Transplant (FETCO) in the Cardiac Rehabilitation Plan, under the supervision of Hospital 12 de Octubre in Madrid. Conclusions: We have developed a complete system that accomplishes Continua guidelines allowing interoperability with Continua-certified medical devices without any change in hospital infrastructure. The assessment of the complete system in a real environment is showing improvements on treatment adherence in cardiac rehabilitation patients. In addition, the system tries to bring patients who have stopped the treatment back to it, which is also obtaining significant success rates. []