title: iMHere: A Novel mHealth System for Supporting Self-Care in Management of Complex and Chronic Conditions.
abstract: BACKGROUND
  Individuals with chronic conditions are vulnerable to secondary complications that can be prevented with adherence to self-care routines. They benefit most from receiving effective treatments beyond acute care, usually in the form of regular follow-up and self-care support in their living environments. One such population is individuals with spina bifida (SB), the most common permanently disabling birth defect in the United States. A Wellness Program at the University of Pittsburgh in which wellness coordinators supervise the care of individuals with chronic disease has produced remarkably improved outcomes. However, time constraints and travel costs have limited its scale. Mobile telehealth service delivery is a potential solution for improving access to care for a larger population.
  
  
  OBJECTIVE
  The project's goal was to develop and implement a novel mHealth system to support complex self-care tasks, continuous adherence to regimens, monitoring of adherence, and secure two-way communications between patients and clinicians.
  
  
  METHODS
  We developed and implemented a novel architecture of mHealth system called iMHere (iMobile Health and Rehabilitation) consisting of smartphone apps, a clinician portal, and a two-way communication protocol connecting the two. The process of implementing iMHere consisted of: (1) requirement analysis to identify clinically important functions that need to be supported, (2) design and development of the apps and the clinician portal, (3) development of efficient real-time bi-directional data exchange between the apps and the clinician portal, (4) usability studies on patients, and (5) implementation of the mHealth system in a clinical service delivery.
  
  
  RESULTS
  There were 9 app features identified as relevant, and 5 apps were considered priority. There were 5 app features designed and developed to address the following issues: medication, skin care, bladder self-catheterization, bowel management, and mental health. The apps were designed to support a patient's self-care tasks, send adherence data to the clinician portal, and receive personalized regimens from the portal. The Web-based portal was designed for clinicians to monitor patients' conditions and to support self-care regimens. The two-way communication protocol was developed to facilitate secure and efficient data exchange between the apps and the portal. The 3 phases of usability study discovered usability issues in the areas of self-care workflow, navigation and interface, and communications between the apps and the portal. The system was used by 14 patients in the first 6 months of the clinical implementation, with 1 drop out due to having a poor wireless connection. The apps have been highly utilized consistently by patients, even those addressing complex issues such as medication and skincare. The patterns of utilization showed an increase in use in the first month, followed by a plateau.
  
  
  CONCLUSIONS
  The system was capable of supporting self-care and adherence to regimen, monitoring adherence, supporting clinician engagement with patients, and has been highly utilized.
authors.affiliation: Department of Health Information Management, School of Health & Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, United States. parmanto@pitt.edu.
authors.forename: Bambang
authors.initials: B
authors.lastname: Parmanto
authors.forename: Gede
authors.initials: G
authors.lastname: Pramana
authors.forename: Daihua Xie
authors.initials: DX
authors.lastname: Yu
authors.forename: Andrea D
authors.initials: AD
authors.lastname: Fairman
authors.forename: Brad E
authors.initials: BE
authors.lastname: Dicianno
authors.forename: Michael P
authors.initials: MP
authors.lastname: McCue
keywords: chronic disease management; clinician-directed self-care; mhealth; mobile health; patient-clinician communications; self-care; self-management; smartphone; spina bifida; telehealth; telemedicine
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