Integrating mHealth in Oncology: Experience in the Province of Trento

• Published in: Journal of medical Internet research Vol. 17; no. 5; p. e114
• Main Authors: Galligioni, Enzo, Piras, Enrico Maria, Galvagni, Michele, Eccher, Claudio, Caramatti, Silvia, Zanolli, Daniela, Santi, Jonni, Berloffa, Flavio, Dianti, Marco, Maines, Francesca, Sannicolò, Mirella, Sandri, Marco, Bragantini, Lara, Ferro, Antonella, Forti, Stefano
• Format: Journal Article
• Language: English
• Published: Canada Journal of Medical Internet Research 01-05-2015; Gunther Eysenbach MD MPH, Associate Professor; JMIR Publications Inc; JMIR Publications
• Subjects: Antineoplastic Agents - therapeutic use; Asthma - therapy; Attitude of Health Personnel; Bar codes; Barcoding; Cancer; Cell Phone; Cellular telephones; Chemotherapy; Chronic illnesses; Computerization; Diabetes Mellitus - therapy; Drug administration; Empowerment; Health education; Health information; Health status; Humans; Hypertension - therapy; Information Systems; Italy; Management; Medical errors; Medical personnel; Medical records; Mobile Applications; Mobile phones; Neoplasms - drug therapy; Nurses; Oncology; Oncology Nursing; Original Paper; Patient compliance; Patient Safety; Patient Satisfaction; Pilot Projects; Point-of-Care Systems; Privacy; Questionnaires; Side effects; Telemedicine - methods; Usefulness; Validity; home monitoring; safe chemotherapy; patient safety; health informatics; mobile health; supportive care
• ISSN: 1438-8871; 1439-4456; 1438-8871
• DOI: 10.2196/jmir.3743

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.
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.
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).
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.
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.