A new mobile-based reminding product for connected health
Submitting InstitutionUniversity of Ulster
Unit of AssessmentComputer Science and Informatics
Summary Impact TypeTechnological
Research Subject Area(s)
Medical and Health Sciences: Clinical Sciences, Public Health and Health Services
Summary of the impact
An internet-based care model developed by CSRI at Ulster, facilitating
all stakeholders (patients, pharmacists, carers, GPs) to dynamically
manage the prescription of, and patient compliance with, medication has
been incorporated into the [text removed for publication] service platform
produced by [text removed for publication], a Telecare product provider.
This has extended functionality of [text removed for publication], which
is now being used by over 400 patients in [text removed for publication],
with improved levels of medication compliance, reduction in caregiver
burden, and improved workflow management for healthcare professionals.
Incorporation of video-based reminders further led to a material transfer
agreement between Ulster and [text removed for publication] to extend
[text removed for publication]'s functionality.
Findings from recent research studies indicate that 91% of adults aged
between 57 and 85 consume at least one item of medication daily, around
76% of prescribed medications are taken incorrectly, and 29% are not taken
at all. When not adhered to correctly, the efficacy of medicated treatment
is sub-optimal, both physiologically and financially. The most commonly
reported reason of non-compliance to medication is forgetfulness.
Research within CSRI has focussed on using technology to aid stakeholders
within a Connected Health environment for over 15 years, with the main
application areas relating to reminding technologies for medication
management  and supporting people with dementia [1, 2, 4].
Ulster were co-ordinators of the EU FP5 MEDICATE project consortium
(2000-2004). Through assessment of stakeholder needs conducted as part of
the MEDICATE project, the patient pathway and stakeholder involvement in
the process of reminding technologies required for medication compliance
were elicited. This work formed the basis for the establishment of a novel
Internet-based care model to support all stakeholders in the supply to
intake chain of personal medication management . Evaluation of this
care model solution demonstrated its effectiveness, with two-thirds of
users showing improved compliance with their prescribed medication regime,
and a reduction in the average caregiver contact time required per week
(from 4.87 hours per week without the solution, to 1.38 hours per week
with the solution) .
The MEDICATE solution was extended to a mobile-based reminding
application  (2004-2007), which inspired the concept of video-based
reminders for persons with dementia. A video-based reminding system,
utilising mobile phone technologies, was developed and evaluated  with
cohorts of elderly users, persons with dementia and control groups, along
with their carers; in total, over 400 days' worth of evaluations were
conducted (2006-2012). The results from this work demonstrated the utility
of the approach from both carer (reduction in caregiver burden) and
patient (improvement in quality-of-life and levels of independence)
perspectives [2, 5].
Analysis following evaluations provided insights into the most
appropriate ways to use video-based messages for medication reminders and
how user interaction with the technology should be designed for people
with dementia . Analysis also identified an additional key challenge:
that of assessing and improving technology adoption . A subset of data
from 40 patients was retrospectively analysed (2011-2013) for user
profiles to assess the success of using assistive technology for people
with dementia. Using this user profile analysis, a technology adoption
model based on a k-NN algorithm was developed to predict the likelihood of
a person with dementia adopting the technology. Results identified 7 key
features in a user's profile that can be used in the model to predict
technology adoption with an accuracy of 84% .
This work has been conducted by a team of key researchers in CSRI:
||Professor of Biomedical Engineering (joined as
||Professor of Mathematics (joined as Research Assistant, 1971)
||Professor of Informatics (joined as Lecturer, 1984)
||Professor of Medical Informatics (joined as Lecturer, 1985)
|Dr Mark Donnelly
||PhD student/Research Associate/Lecturer (10/2004-present)
|Dr Dewar Finlay
||Research Associate/Lecturer/Senior Lecturer (06/2000-present)
|Dr Sonja O’Neill
||Research Associate (03/2010-01/2012)
|Mr Richard Davies
||Research Associate/Lecturer (07/2001-present)
|Dr Shuai Zhang
||Research Associate/Lecturer (08/2009-present)
|Dr Leo Galway
||Research Associate/Lecturer (05/2010-present)
References to the research
* References that best indicate the quality of the underpinning
 * RJ Davies, CD Nugent, MP Donnelly, M Hettinga, FJ Meiland, F
Moelaert, MD Mulvenna, JE Bengtsson, D Craig, RM Droes (2009). A
User-driven Approach to Develop a Cognitive Prosthetic to Address the
Unmet Needs of People with Mild Dementia, Pervasive and Mobile
Computing, vol. 5, no. 3, pp. 253-267.
[This paper is included as an output in the current REF submission.]
 * MP Donnelly, CD Nugent, S Mason, SI McClean, BW Scotney, AP
Passmore, D Craig (2010). A Mobile Multimedia Technology to Aid Those with
Alzheimer's Disease, IEEE Multimedia, vol. 17, no. 2, pp. 42-51.
[This paper is included as an output in the current REF submission.]
 CD Nugent, D Finlay, RJ Davies, MD Mulvenna, JG Wallace, C Paggetti,
E Tamburini, ND Black (2007). The
Next Generation of Mobile Medication Management Solutions, International
Journal of Electronic Healthcare, vol. 3, no. 1, pp. 7-31.
 CD Nugent (2007). ICT in the Elderly and Dementia, Ageing and
Mental Health, vol. 11, no. 5, pp. 473-476.
 SA O'Neill (nee Weber), S Mason, G Parente, MP Donnelly, CD Nugent,
SI McClean, BW Scotney, D Craig (2011). Video Reminders as Cognitive
Prosthetics for People with Dementia, Ageing International, vol.
36, no. 2, pp. 267-282.
 * S Zhang, SI McClean, CD Nugent, MP Donnelly, L Galway, BW Scotney,
I Cleland (2013). A Predictive Model for Assistive Technology Adoption for
People with Dementia, IEEE Journal of Biomedical and Health
Informatics, (available on-line).
[This paper is included as an output in the current REF submission.]
Project: Determining the Value of User Needs in the Product Design
of Cognitive Prosthetics
Funder: EPSRC (via Brunel: EP/G012393/1) £171,861 (to Ulster)
Ulster grant-holders: CD Nugent, MP Donnelly, SI McClean, BW Scotney, D
Dixon, B Meenan
Project: Cell Phone Video Streaming in Alzheimer's Disease
Funder: Alzheimer's Association (ETAC-06-26017) £70,673 (to Ulster)
Ulster grant-holders: CD Nugent, MD Mulvenna, SI McClean, BW Scotney
Project: TAUT: Technology Adoption and Prediction Tools for
Funder: Alzheimer's Association (ETAC-12-242841) £128,205 (to Ulster)
Ulster grant-holders: CD Nugent, SI McClean, MP Donnelly, BW Scotney
Project: MEDICATE: The control, Identification and Delivery of
Funder: EU FP5 (IST-2000-27618) £378,378 (to Ulster),
Ulster grant-holders: ND Black, CD Nugent
Details of the impact
[text removed for publication],an [text removed for publication] SME
telecare product provider, has incorporated our research results from the
MEDICATE project relating to mobile-based medication management, for which
Ulster were project co-ordinators, into their flagship telecare product
[text removed for publication]. As a result, [text removed for
publication] have reported increases in revenue, the number of [text
removed for publication] users, and the number of R&D staff they
employ to develop the product.
Based on the outcomes from the MEDICATE Project (2004) it was recommended
by the European Commission/ Review Panel of Experts that efforts should be
made to translate the project findings into commercial products [E1].
Based on this recommendation, CSRI and [text removed for publication]
worked together to build upon the findings from the research (2004-2007).
This led to the incorporation of research results on Internet- and
mobile-based care models [text removed for publication] into [text removed
for publication] product for a mobile phone-based service for medication
management and improved workflow management (stakeholder needs,
information flow between stakeholders, critical path analysis) for
patients, pharmacists, carers and GPs.
Incorporation of this new functionality into [text removed for
publication] during 2008 extended the services previously offered (vital
sign monitoring, agenda management, video-conferencing) [E2]. The
translation of our research results (mobile-based medication management
and workflow management) into the [text removed for publication] product
has been fully recognised and acknowledged by the company, along with the
resulting positive economic impact for [text removed for publication]
[E3]. Since incorporation of the new functionality into the [text removed
for publication] product in 2008, the company has reported:
- securing [text removed for publication] contracts for the [text
removed for publication] product, yielding a total revenue of [text
removed for publication] [E3];
- creating [text removed for publication] additional new posts for
research and development engineers to further develop the [text removed
for publication] product [E3];
- use of the [text removed for publication] system by over 400 users
within the [text removed for publication] region managed by the [text
removed for publication] [E3].
From a healthcare perspective, General Practitioners have reported the
positive benefits of being able to monitor patients remotely using the
[text removed for publication] system without the need for home-based
visits [E4]. From the patients' perspective, positive feedback has been
provided about how [text removed for publication] provides a solution that
offers constant monitoring and communication with a doctor [E4].
The collaboration between CSRI and [text removed for publication] to
develop [text removed for publication] was extended further in 2012
through a Material Transfer Agreement and exclusive licensing option with
CSRI [E5] (which [text removed for publication] opted to progress in June
2013). The agreement supported the incorporation into [text removed for
publication] of the know-how acquired by CSRI about reminding solutions
for persons with dementia. This know-how involved the architecture for
video-based reminders being delivered via mobile phones, and the workflow
associated with medication non-compliance. Prior to this, the [text
removed for publication] platform did not provide tailored solutions for
home-based support of persons with dementia. A joint commercial venture
between CSRI and [text removed for publication] was established in
November 2012, [text removed for publication] [E6]. The aim of the joint
venture is to provide support for the [text removed for publication]
product within the UK, from both marketing and installation perspectives,
to promote the further uptake of [text removed for publication] within
Europe; [text removed for publication] will also continue to investigate
opportunities to extend the current levels of services that [text removed
for publication] offers.
During 2012 the Institute for Employment Studies were commissioned by the
Social Care Institute for Excellence to seek examples of how technology
had been used to enhance the lives of people with dementia. The aim of the
work was to draw together all the current research literature within the
domain and to produce an up-to-date best practice guidance document that
would support care workers in their use of technology when working with
people with dementia. In this process, the Institute for Employment
Studies highlighted the research being undertaken in CSRI relating to
assistive technologies, and Prof Nugent was invited to join an Expert
Panel with a brief to support the production of the best-practice guidance
document. The outcome of the Expert Panel Workshop led to the production
of a guide for social care providers that is described as "a short
introduction to using information and communication technology (ICT) in
activities for people with dementia" [E7]. The guidance document has been
aimed at managers and staff in the care sector and providers of activities
for people with dementia.
Based also on a general appreciation for the expertise acquired by CSRI
[E8] from our research on technology-based solutions for persons with
dementia, Prof Nugent was also invited by the NI Health and Social Care
R&D Division to join a priority setting exercise to help support the
agenda definition for research into dementia care in Northern Ireland
[E9]. A call for proposals was subsequently launched by the HSC R&D
Office in June 2013, which included the recommendations to include
technology-based solutions as a thematic action line.
Sources to corroborate the impact
[E1] Excerpt from the final report of the EU Commission on MEDICATE
Project. This item provides corroborating evidence of the recommendation
to undertake further efforts to commercialise findings of the MEDICATE
project to appreciate real impact.
[E2] Product brochure from [text removed for publication]. [text removed
for publication] This item provides corroborating evidence of the
medication reminding solutions incorporated into the [text removed for
[E3] A Factual Statement in the form of a letter from [text removed for
publication]. This item provides corroborating evidence that the company,
[text removed for publication], achieved increased revenue and job
creation, and of the extent of the usage of the [text removed for
[E4] Stakeholder testimonials provided by patient and healthcare
professionals who are users of the [text removed for publication] product.
These items provide corroborating evidence of positive experiences of
using the [text removed for publication] product by healthcare
professionals and patients.
[E5] Material Transfer agreement. This item provides corroborating
evidence of the exclusive agreement between University of Ulster and [text
removed for publication] to license know-how in video based reminders.
[E6] Legal documents from the spin-out company [text removed for
publication]. This item provides corroborating evidence of the spin-out
[E7] Using ICT activities for people with dementia: training material
available on the Social Care Institute for Excellence website: http://www.scie.org.uk/publications/ictfordementia/index.asp
This item provides corroborating evidence of translation of research
findings into material to be used by carers.
[E8] Newspaper story (Newtownabbey Times) of a Technology Open Day run by
CSRI at Inniscoole Day Centre, Belfast (16th August, 2012). This item
provides corroborating evidence of raising awareness of technology-based
solutions within the community.
[E9] Letter of invitation from the Director of the Northern Ireland HSC
R&D Division to join the Priority Setting Exercise on research in
dementia care. This item provides corroborating evidence demonstrating
participation in the Priority Setting Exercise for Research into Dementia
Care in Northern Ireland.