Translated with google translate

System for support of clinical solutions for personalized recovery after COVID-19 and online tools for self-participation in health care

1. Database:

1.1. Identification and collection of information on:

a) Scientific communications relevant to the topic of rehabilitation – from available sources;

Hired experts collect articles and publications (including photos), classify the sources and provide links to them so that physicians can get acquainted with the scientific reports.

Selected part of the information is translated and made available through the site.

b) The key observed effects on each of the human body systems (or symptoms?) and which clinical parameters should be measured to control these icings – by examining the degree of consensus of experts and expert opinions on the significance of each of the observed and reported in the scientific literature consequences (or symptoms?);

c) Possible physiotherapeutic interventions on each of the identified consequences – by examining the degree of consensus of experts and expert opinions on the presence of therapeutic impact (therapeutic benefits) of the respective physiotherapeutic procedure on the consequences of COVID 19;

d) The portfolio of possible physiotherapeutic interventions, which are offered by the medical establishments for rehabilitation registered on the site – by collecting and updating information and offers from these establishments;

e) The details necessary for the development of the tourist product (for health tourism) and of the basic and additional services related to the provision of physiotherapeutic interventions (specifications of physiotherapeutic procedures, health professionals, location, distance to the airport, station, bus station, type accommodation, type of meal, what is included in the price, details of the stay (pets, entertainment, sports & nature, culture and history, climate, parking places, etc.)

1.2. Determination of values ​​reflecting the “degree of therapeutic effect” of each of the possible physiotherapeutic interventions on each of the identified key (significant) observed effects (or symptoms?):

1.3. Determination of values ​​reflecting the “ease of application” of each of the physiotherapeutic interventions on each of the key symptoms

1.4. Analysis of the effectiveness of physiotherapeutic interventions that experts have found to have a therapeutic effect (therapeutic benefits) on any consequence of COVID 19.

1.5. Prioritize the most effective physiotherapy interventions and combine them into packages, looking for synergistic effects of the combination.

Physiotherapists and physicians who assess the degree of therapeutic impact should receive from the developer an online interface through which they can conveniently determine and plot values.

The values ​​are determined jointly with specialists and practitioners in health management.

1.6 General provisions

In this pilot project, the medical decision support system will initially be implemented through more basic tools – math programs and spreadsheets. Their interface is familiar, they have built-in formulas and logic that allow you to solve problems, contain built-in languages ​​and macros for more complex models, allow you to use data from other databases and convert.

Initially, the “Prioritization Matrix” will be used, based on the model developed by A. Hartman and J. Sifonis

Only at the next stage, when empirical information is accumulated from the operation of this more basic system, it is possible to envisage the creation of specialized software with built-in models with the characteristics of full artificial intelligence to support medical solutions in the field of physiotherapy. treatment of the consequences of COVID 19.

a) N physiotherapists evaluate the degree of therapeutic effect, on a scale from 0 to 3 (0 – no effect; 1 – low effect; 2- medium effect; 3 – strong effect)

b) the results of the physiotherapists are averaged ……. (how ??)

“Ease” is assessed according to: price, how much depends on the qualification of the staff, organizational convenience (eg: remoteness, temperature), patient comfort during the procedure, external restraints, risks and side effects, complementarity with another procedure, contraindications, image of the procedure to patients)

  The method developed for project prioritization will be applied to prioritize physiotherapy interventions once adapted. The “economic benefits” used in the original method to determine the ordinate values ​​are replaced by “therapeutic benefits”, ie by “the degree of therapeutic effect”.

2. Module for algorithmic diagnostics

THIS IS THE CHALLENGE! This module is key to the project!

2.1. Completion of a system of existing on the market clinical instruments sensors and devices in the field of the so-called. “Self data” and from developed tests, questionnaires for self-diagnosis and self-testing of the consequences of COVID 19.

The initial market research will cover instruments, sensors and devices for self-measurement: blood pressure, SpO2, body weight, fitness indicators, respiratory rate / number of breaths per minute, heart rate, body temperature, PEF, FEV and blood sugar).

WHICH OF THEM, OR OTHERS, WILL BE INCLUDED IN THE SYSTEM WILL BE DECIDED BY THE DOCTORS, in agreement with the developer. This will be done in step 1.1.1 b)

Tests are specific tools (rating scales) that allow you to classify the severity of a symptom by turning the subjective personal experience of different sensations into a numerical parameter showing the intensity of the experienced sensation.

The medical part of the tests, questionnaires for self-diagnosis and self-testing of the consequences of KOVID 19 will be set by the medical team, and in coordination with them, the developer should offer a friendly interface for easy testing.

The rocks are distinguished from each other and will be used:

‘discriminatory’ (which distinguish populations in the study based on the level of perception of sensation) from ‘evaluative’ (which identify variations in baseline).

“categorical” scales, which quantify the sensation according to the categories (light, moderate and severe), from “analogue” scales (where the determination of the weight is by analogy).

“direct” (which directly examines the level of perceived sensation) from “indirect” (which evaluates, for example, activities that are limited in everyday life).

“one-dimensional” scales (which take into account only the type of activity that provokes the sensation) from the “multidimensional” scales (which also take into account other aspects, such as functional impairment, load size, degree of effort associated with the sensation).

 – ‘clinical’ (completed by the patient during a medical interview) by ‘psycho-physical’ (assessing the intensity of the symptom in response to a stimulus, exercise or medication).

2.2. Development of interfaces to clinical instruments, sensors and devices and devices, tests, questionnaires for self-diagnosis and self-testing of the consequences of COVID 19

In order to accept for processing their patient records.

Existing devices / sensors that connect to a computer or telephone via cable, WiFi or Bluetooth are identified – examples of which can be found here.

Appropriate devices / sensors are offered to the medical and administrative team of the project and together those that are suitable are selected (on which the data can be read, or on which the manufacturer has described the interfaces, protocols well enough).

Some manufacturers are offered to install their sensor in the system and on this basis to request additional information. Theoretically, we can negotiate with manufacturers, and make us interfaces, especially if we find manufacturers – SMEs.

When sensors are selected – the programmers will make / use the available interfaces (mobile or web) for them.

2.3. Digitization and unambiguous identification of patient records from multiple information systems (received medical records, questionnaires for self-diagnosis and self-testing, tests, examinations, results of imaging and functional diagnostics), which provide diverse, poorly structured, semi-structured and unstructured information.

This poorly structured information is designed to help decision makers – people who also face poorly structured problems.

“Objectification” of some determinants of human health, such as physical activity, diet, interactions with others, self-judgment, etc.

Both hypotheses are possible in practice, so they will be developed:

a / Input and storage of scanned or photographed documents.

b / Completion of unified forms for research results (by user or moderator).

2.4. Development of an expert system / artificial intelligence for determination (through analysis of patient records) of:

a / the initial condition / diagnosis, upon admission of the patient and the final one – upon discharge;

b / the rehabilitation potential of the patient;

c / the recommended rehabilitation interventions (procedures) and their intensity, duration and frequency, depending on the rehabilitation potential of the patient and the efficiency of the respective rehabilitation intervention / procedure already determined by the X / C Matrix.

2.5. It is sad, but there are NO unified or at least generally accepted standards for digital provision of measured clinical parameters.

However, there are enough economically available connected devices (sensors) in the field of “self data” – once they buy them, then they are probably technically reliable. Each sensor somehow connects to provide processing information. Remote and personalized medicine have entered a lot, connected devices, DSS systems, mobile applications that are “fed” by such sensors – a lot. They can be used to set a standard for the collection and management of health data collected and measured.

For the other type of data (reported patient results and test results) we will develop our own standards or we will use someone else’s.

2.6. The final answer to the questions “which data are decisive?” And “are they unambiguous?” Will be given by the medical team after the start of the project.

For the time being, on the basis of the available scientific publications, it can be expected that the data from the treatment will be decisive (and unambiguous) for all patients: mild and moderate form – treated at home; severe form – treated in hospital; severe form treated at home due to lack of place in hospital; very severe form – treated in the intensive care unit + breathing; large doses of cortisone;

Unambiguously determining for all are the previous diseases before KOVID-19: hypertension; CNS diseases (epilepsy, IMI, peripheral); liver problems; diabetes; kidney problems; kidney stone disease, etc.)

For the individual patient, some of the parameters are unambiguous, and others – in relation to other parameters. It is expected that determining, depending on the consequences of KOVID-19, will be several of the following indicators, which must be presented digitally:

cough dyspnea – according to MRC self-assessment fatigue / shortness of breath – assessment according to Borg 6 minute test FID restrictive FID obstructive walking capacity 6 ′ cardio-respiratory deficiency muscle skeletal indicators respiratory-muscular dysfunction laryngeal obstruction residual pulmonary fibrosis pulse oximetry before 6 ′ test pulse oximetry after 6 ′ test RR before and after 6 min test heart rate – before 6 ′ test heart rate – after 6 ′ test weight lossanamnestic and PP hypertension decreased muscle strength elbow flexion 5,4,3,2 TBS 5,4,3 – anamnestic, prolonged pain weakness concr. muscle groups lost nerve liver pigments in urine echo liver echo bile echo kidneys Le, Er, protein in the urine skin problems hair loss exfoliation of the skin heart problems defects, CH and coronary heart disease blood sugar and sugar in the urineheart problems arrhythmias myocarditis ECG CNS disorders vestibular disorders IMI at the time encephalitis, myelitis fatigue ageusia anosmia memory loss disturbance in concentration sleep disorders depression test anxiety test clinical impressions

This is a “long list”, ie an extended list of parameters, the project medical team is expected to suggest that some of the listed parameters be dropped from this list.

2.7. IMPORTANT: The expert system does not have the task to diagnose, but to recommend which rehabilitation interventions (procedures) should be applied and their intensity.

The final decision is made by the physiotherapist.

The digital presentation of the parameters and their relativity requires a serious expert medical resource, which must be provided.

3. Module for measuring and monitoring the effect of physiotherapy intervention

3.1. Personal account (personal account)

This is the patient’s personal space on the corporate site.

Similar to the websites of airlines, institutions, hospitals – places that provide personal services and in which the user’s personality matters.

The personal account is available only for registered patients, access is by password.

Through it, personal information is accessed, both in raw form and processed (personal program, recovery trend, analysis of indicators, …), personal advice, recipes, ……

Bonuses and promotional points can be accumulated.

Requests, requests, proposals, complaints are submitted through the personal account,

3.2. Patient diary

The data is entered via a mobile phone or the personal account of the patient / doctor.

If necessary, the data can be passed on to a specialist.

After receiving the data from the received documents, questionnaires for self-diagnosis and self-testing, tests and results of clinical instruments, sensors and devices, imaging and functional diagnostics and examinations, the server returns to the phone statistics for the previous days (can be divided into time zones morning, noon, evening and at bedtime).

For easier interpretation and comprehensibility, the data are presented in the form of tables and graphs

And after receiving the data, a confirmation is returned that the data was received in any format, as long as it is applicable and adequate.

Also returns a histogram with a color indication of the established and reference levels, the established and standard deviations, the frequency of episodes (if any). The idea is to encourage patients to pay more attention to physiotherapy procedures and to adjust their lifestyle.

3.3. Low and high levels are monitored and, if necessary, the patient and the responsible healthcare provider are alerted via an SMS message (function for reminding and warning and anticipating risks);

3.4. Recommendations for rehabilitation after discharge.

3.5 Each patient has his own reference thresholds (minimum and maximum) levels of the given parameter, taking into account the patient’s condition and the stage of rehabilitation.

3.6 Through game moments (role-plays, simulation, dramatization) can patients be encouraged to take their measurements as many times a day as necessary?

Learners are placed in a real situation, each in a specific role, with clear instructions for action and the end result. Applied in a group, online.

The role play can be spontaneous, the task can be given for homework – as a study, and the play can take place in the group. Role play can also be used as an assessment.

The invention of case studies and methodological materials are the concern of external contractors.

3.7 Patients at higher risk of deterioration are prioritized in the system

3.8 It provides an opportunity to accumulate comparable and compatible health data for research purposes

4. Module for accompanying the patient after discharge

4.1. Telemedicine system based on GPRS and telephone, telephone and WEB feedback

4.2. Mobile phone software

4.3. Free access (during working hours) to a medical person for advice and virtual rehabilitation assistance. Chat + option for voice communication + sending photos, copies of documents, etc.

4.4. “Personal account”

4.5. Patient diary for recording subjective symptoms and complaints, questions related to procedures and measurements

4.6. The access to the data is controlled – different rights for access of a patient, a healthcare person, technical support, possibly – the healthcare system are defined.

The access to the information on the server is done through a standard internet browser, through the “personal account” page of the patient, protection – with a password.

4.7. Option to turn on “Machine vision” – camera, for remote viewing.

4.8. Integrate some of the specially developed games that improve cognitive functions – for those who have been seriously ill and have lost some cognitive functions.

In a fun way, they help create neural connections and networks in the areas of the brain responsible for lost skills. (The brain functions like a muscle: as you train it, it develops when you don’t use it – it stunts). Can be combined with music, sounds.

Appropriate video games will also be used.

5. Patient education module:

5.1. All Methodologies and medical consensuses on rehabilitation after KOVID 19 insist:

– Patients should be trained on how to continue rehabilitation after discharge, procedures, regimen, diet, self-measurement and self-testing, “yellow” and “red” flags (critical value measured parameters), precautions against re-infection, etc. .

– to be trained and their relatives, how to assist them in recovery and how to protect them.

– train medical professionals on the use of digital tools and on innovations.

– both are trained in knowledge of national legal and administrative frameworks.

5.2. This can be done (during recovery in a restaurant) and online.

As recovery in a hospital / sanatorium is not a rest but a heavy activity, there is little time and effort left for training, so it is extremely important to train afterwards, online, “at home” and to ensure continuity between hospital / sanatorium training and -training then, online, «home»

5.3. Interested authorities are given the opportunity to integrate their rehabilitation and training programs online.

5.4. Includes tools for communication, information and motivation.

5.5. Includes referral tools:

– on good physical condition or proper diet

– about lifestyle, daily activities

5.6. Used:

– educational videos;

– instruction manuals;

– remote consultation (telerehabilitation);

6. Virtual community establishment module

6.1. The virtual community will be formed on the basis of common interest

It will be a tool for communication of people with a similar problem, good practices, problems, impressions from specific providers of therapeutic effects will be discussed.

6.2. It will be transnational, transcultural.

6.3. What it will look like – those for whom it is intended to give good ideas will be asked, but it will be something like a “forum” with patients and victims of KOVID 19.

6.4. The role of the IT developer in “establishing” this community is to create an environment, a tool for communication, to avoid the use of controlled and censored social networks.

Electronic stethoscopes

Digital devices for cardiac auscultation