title: Integrating mHealth in Oncology: Experience in the Province of Trento.
abstract: BACKGROUND
  The potential benefits of the introduction of electronic and mobile health (mHealth) information technologies, to support the safe delivery of intravenous chemotherapy or oral anticancer therapies, could be exponential in the context of a highly integrated computerized system.
  
  
  OBJECTIVE
  Here we describe a safe therapy mobile (STM) system for the safe delivery of intravenous chemotherapy, and a home monitoring system for monitoring and managing toxicity and improving adherence in patients receiving oral anticancer therapies at home.
  
  
  METHODS
  The STM system is fully integrated with the electronic oncological patient record. After the prescription of chemotherapy, specific barcodes are automatically associated with the patient and each drug, and a bedside barcode reader checks the patient, nurse, infusion bag, and drug sequence in order to trace the entire administration process, which is then entered in the patient's record. The usability and acceptability of the system was investigated by means of a modified questionnaire administered to nurses. The home monitoring system consists of a mobile phone or tablet diary app, which allows patients to record their state of health, the medications taken, their side effects, and a Web dashboard that allows health professionals to check the patient data and monitor toxicity and treatment adherence. A built-in rule-based alarm module notifies health care professionals of critical conditions. Initially developed for chronic patients, the system has been subsequently customized in order to monitor home treatments with capecitabine or sunitinib in cancer patients (Onco-TreC).
  
  
  RESULTS
  The STM system never failed to match the patient/nurse/drug sequence association correctly, and proved to be accurate and reliable in tracing and recording the entire administration process. The questionnaires revealed that the users were generally satisfied and had a positive perception of the system's usefulness and ease of use, and the quality of their working lives. The pilot studies with the home monitoring system with 43 chronic patients have shown that the approach is reliable and useful for clinicians and patients, but it is also necessary to pay attention to the expectations that mHealth solutions may raise in users. The Onco-TreC version has been successfully laboratory tested, and is now ready for validation.
  
  
  CONCLUSIONS
  The STM and Onco-TreC systems are fully integrated with our complex and composite information system, which guarantees privacy, security, interoperability, and real-time communications between patients and health professionals. They need to be validated in order to confirm their positive contribution to the safer administration of anticancer drugs.
authors.affiliation: Medical Oncology Department, Azienda Provinciale per i Servizi Sanitari, Trento, Italy. enzo.galligioni@apss.tn.it.
authors.forename: Enzo
authors.identifier: http://orcid.org/0000-0001-7395-8322
authors.initials: E
authors.lastname: Galligioni
authors.forename: Enrico Maria
authors.identifier: http://orcid.org/0000-0002-6115-0577
authors.initials: EM
authors.lastname: Piras
authors.forename: Michele
authors.identifier: http://orcid.org/0000-0001-6491-2736
authors.initials: M
authors.lastname: Galvagni
authors.forename: Claudio
authors.identifier: http://orcid.org/0000-0001-9643-0088
authors.initials: C
authors.lastname: Eccher
authors.forename: Silvia
authors.identifier: http://orcid.org/0000-0002-8693-5151
authors.initials: S
authors.lastname: Caramatti
authors.forename: Daniela
authors.identifier: http://orcid.org/0000-0003-0282-1278
authors.initials: D
authors.lastname: Zanolli
authors.forename: Jonni
authors.identifier: http://orcid.org/0000-0003-1345-0118
authors.initials: J
authors.lastname: Santi
authors.forename: Flavio
authors.identifier: http://orcid.org/0000-0002-4894-3484
authors.initials: F
authors.lastname: Berloffa
authors.forename: Marco
authors.identifier: http://orcid.org/0000-0002-1404-1423
authors.initials: M
authors.lastname: Dianti
authors.forename: Francesca
authors.identifier: http://orcid.org/0000-0003-2710-1314
authors.initials: F
authors.lastname: Maines
authors.forename: Mirella
authors.identifier: http://orcid.org/0000-0002-6408-6654
authors.initials: M
authors.lastname: Sannicolò
authors.forename: Marco
authors.identifier: http://orcid.org/0000-0001-7132-1627
authors.initials: M
authors.lastname: Sandri
authors.forename: Lara
authors.identifier: http://orcid.org/0000-0002-5751-5545
authors.initials: L
authors.lastname: Bragantini
authors.forename: Antonella
authors.identifier: http://orcid.org/0000-0003-4109-6769
authors.initials: A
authors.lastname: Ferro
authors.forename: Stefano
authors.identifier: http://orcid.org/0000-0003-3471-2033
authors.initials: S
authors.lastname: Forti
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000628:therapy*; D001291:Attitude of Health Personnel; D040421:Cell Phone; D003920:Diabetes Mellitus / Q000628:therapy*; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D007256:Information Systems; D007558:Italy; D063731:Mobile Applications; D009369:Neoplasms / Q000188:drug therapy*; D009859:Oncology Nursing; D061214:Patient Safety; D017060:Patient Satisfaction; D010865:Pilot Projects; D019095:Point-of-Care Systems; D017216:Telemedicine / Q000379:methods*
chemical_list: D000970:Antineoplastic Agents
keywords: health informatics; home monitoring; mobile health; patient safety; safe chemotherapy; supportive care