title: Digital health system for personalised COPD long-term management.
abstract: Recent telehealth studies have demonstrated minor impact on patients affected by long-term conditions. The use of technology does not guarantee the compliance required for sustained collection of high-quality symptom and physiological data. Remote monitoring alone is not sufficient for successful disease management. A patient-centred design approach is needed in order to allow the personalisation of interventions and encourage the completion of daily self-management tasks.
  
  
  
  A digital health system was designed to support patients suffering from chronic obstructive pulmonary disease in self-managing their condition. The system includes a mobile application running on a consumer tablet personal computer and a secure backend server accessible to the health professionals in charge of patient management. The patient daily routine included the completion of an adaptive, electronic symptom diary on the tablet, and the measurement of oxygen saturation via a wireless pulse oximeter.
  
  
  
  The design of the system was based on a patient-centred design approach, informed by patient workshops. One hundred and ten patients in the intervention arm of a randomised controlled trial were subsequently given the tablet computer and pulse oximeter for a 12-month period. Patients were encouraged, but not mandated, to use the digital health system daily. The average used was 6.0 times a week by all those who participated in the full trial. Three months after enrolment, patients were able to complete their symptom diary and oxygen saturation measurement in less than 1 m 40s (96% of symptom diaries). Custom algorithms, based on the self-monitoring data collected during the first 50 days of use, were developed to personalise alert thresholds.
  
  
  
  Strategies and tools aimed at refining a digital health intervention require iterative use to enable convergence on an optimal, usable design. 'Continuous improvement' allowed feedback from users to have an immediate impact on the design of the system (e.g., collection of quality data), resulting in high compliance with self-monitoring over a prolonged period of time (12-month). Health professionals were prompted by prioritisation algorithms to review patient data, which led to their regular use of the remote monitoring website throughout the trial.
  
  
  
  Trial registration: ISRCTN40367841 . Registered 17/10/2012.
authors.affiliation: Department of Engineering Science, University of Oxford, IBME, Oxford, UK. carmelo.velardo@eng.ox.ac.uk.
authors.forename: Carmelo
authors.identifier: 0000-0003-4836-3743
authors.initials: C
authors.lastname: Velardo
authors.affiliation: Department of Engineering Science, University of Oxford, IBME, Oxford, UK.
authors.forename: Syed Ahmar
authors.initials: SA
authors.lastname: Shah
authors.affiliation: Department of Engineering Science, University of Oxford, IBME, Oxford, UK.
authors.forename: Oliver
authors.initials: O
authors.lastname: Gibson
authors.affiliation: Department of Engineering Science, University of Oxford, IBME, Oxford, UK.
authors.forename: Gari
authors.initials: G
authors.lastname: Clifford
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Carl
authors.initials: C
authors.lastname: Heneghan
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Rutter
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Farmer
authors.affiliation: Department of Engineering Science, University of Oxford, IBME, Oxford, UK.
authors.forename: Lionel
authors.initials: L
authors.lastname: Tarassenko
mesh_terms: D034201:Computers, Handheld; D006801:Humans; D008491:Medical Informatics Applications; D018670:Monitoring, Ambulatory / Q000379:methods* / Q000592:standards; D010092:Oximetry; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012648:Self Care / Q000379:methods*; D017216:Telemedicine / Q000379:methods* / Q000592:standards
keywords: Adaptive thresholds; Automatic alerts; COPD; Digital health; Self-management