A Mobile Health Solution to Improve Surgery Outcome

A MOBILE HEALTH SOLUTION TO IMPROVE SURGERY OUTCOME
A MOBILE HEALTH SOLUTION TO IMPROVE SURGERY OUTCOME
Ravina Paresh Kaniyawala
Auckland University of Technology
Supervisor: Dr. Roopak Sinha

A MOBILE HEALTH SOLUTION TO IMPROVE SURGERY OUTCOME
1. Introduction:
The modern world has witnessed an enormous growth in technology and scientific advancement
through the implementation of several mobile applications and smart gadgets that made life
easier and more convenient. Information technology plays a significant role in improving patient
care and with its advancements, it is widely used in all sectors including health care
organizations to provide an accurate and right care to the patients, access patient’s necessary
information, keep record, make communication between physician and patient more convenient,
ensure transparency in medical charge, provide the patient information and enable them to keep
tract on themselves with the help of mobile application, thereby increasing the overall outcome
of the patient’ health and ensuring patient’s satisfaction (Bowles, Dykes & Demiris, 2015). It
falls under the responsibility of the healthcare providers to assist patients with quality care during
pre-surgery, in the course of surgery and also post-surgery and therefore, a detail survey needs to
be brought into effect that aims at improving patient’s life by giving them facilities to track their
activities after surgery and enable them to directly report to the doctor so that they can be
monitored very closely (Lu et al., 2018). The m-health solution should be designed in such a
way so as to incorporate the surgical methods and manual things involved in the surgery to get a
clear information of the surgical treatment. It should contain the devices used in the surgery like
heart measuring device, body sensor and other smart gadgets so that patient’s activity can be
monitored after the surgery (Semple & Armstrong, 2016). The aim and purpose of this research
paper is to propose, create and implement certain technological facilities that can help doctors
and patient ease their communication which will ultimately result in an improved health outcome
of the patients.
The three research questions for this project are provided below:
1. What are the primary requirements from relevant industry and medical standards involved in
effecting and monitoring surgery- related health plans?
2. How can a mHealth platform be architected to meet the primary requirements identified in
RQ1?
3. How can a prototype of the mHealth platform identified in RQ2, consisting of a mobile app
for patients and a web interface for clinicians, be built?

A MOBILE HEALTH SOLUTION TO IMPROVE SURGERY OUTCOME
2. Background:
Smart devices has been established that has changed people’s lives and made everything more
convenient. Recent studies have shown the implementation of Information Technology in
healthcare sectors and their association with improving patient’s life and therefore increases the
patient’s overall satisfaction. Patient’s experience and satisfaction is considered to be an
important outcome in medical health care and it makes the central pillars of health care quality
(Lu et al., 2018). The satisfaction is associated with the treatment and care they receive from the
medical practitioners that influence their perception about quality care. Therefore, the usage of
mobile health applications has helped to improve the quality of healthcare and it has been proven
that through the installation of several facilities like reminders and diagnostic information into
the mobile application can promote the patient’s experience, satisfaction and health (Lu et al.,
2018). In surgical care, there is a growing drift towards reducing the amount of days staying in
the hospital and indulging patients into self-care. However, expedited discharge can lead to poor
outcome of the patients thereby increasing the health complications. Therefore, to address this
challenge, mobile applications has been discovered and developed to facilitate monitoring and
support discharge of the patients ensuring quality care (Semple & Armstrong, 2016).

A MOBILE HEALTH SOLUTION TO IMPROVE SURGERY OUTCOME
3. Literature Review
3.1 Method of Literature Review
The purpose of this literature review is to discuss every aspects of this Mobile Health
Information Management system through conducting a systematic review of various secondary
data resources such as Books, Articles, Published Reports and others. Most of the resources
reviewed for this research are collected from online databases such as NCBI dataase, Google
Scholars, Biomedcentral and others. Several keywords have been used to collect the relevant
literatures on this topic such as biomedical mobile application, medical informatics application,
surgery applications for mobile devices and mobile health application.
Database of Secondary
resources
Key words used for research Boolean functions for
research
 NCBI dataase
 Google Scholars
 Biomedcentral
 Researchgate
biomedical mobile
application
medical informatics
application
surgery applications for
mobile devices and mobile
health application
 -
 “”
 NOT
 AND
 OR
 Capital letters
3.2 Systematic Research
Also referred to as mHealth, mobile health is an umbrella term that refers to the use of mobile
devices in the practice of public health and medicine. The term is generally used for referring to
mobile phones, computers, tablets, and smart watches, and has emerged in recent years as a
major segment of electronic health. Mobile health has been found imperative in breaking down
the obstructions of distance for countryside New Zealanders, for more than 16 years and efforts
are currently being taken by the government to ensure that health professionals and patients
obtain fairness of ‘face-to-face’ communication and access to necessary healthcare services
(Mhurchu et al., 2014). This was in accordance to Perera (2018) who stated that notwithstanding
the obtainability numerous actuator and sensor devices intended to co-perform, few of them can
be integrated in smart homes. Their findings suggested that Internet of Things and ICT are
associated with a range of benefits, including low-cost and low-power devices that can be used
for developing a network that comprises of interconnected smart objects. It has also been stated
by Dowdeswell, Sinha and Haemmerle (2016) that cyber-physical systems are able to exert a
control over multifaceted physical components and processes, at the time of cooperating in the
form of distributed network agents. Furthermore, owing to the complexity and scale of
interactions that are associated with cyber-physical systems, it is difficult to maintain and
implement traceability policies that are precise and easy to accomplish.

A MOBILE HEALTH SOLUTION TO IMPROVE SURGERY OUTCOME
According to Grissinger (2016) automatic alerts can deliver an actual means of disseminating
indispensable information about a patient and the intervention to clinicians who are entitled with
the responsibility of prescribing, dispensing, and administering the intended treatment regimen.
These alerts are envisioned to upkeep medical decisions about the efficacy and safety of
pharmaceutical therapies. In addition, the alerts are characteristically communicated through
different cautionary posts that arrive on the screen of mobile health devices. Furthermore, no or
minimal acknowledgment or action, in relation to the alert on mobile device is generally
obligatory on the part of the users to continue. It has been affirmed by Sanger et al. (2014) that
surgical site infections (SSI) that occur after discharge of patients from hospitals have been
identified as a major reason behind morbidity, expenditure and concern for the patients.
Nonetheless, perceptions amid patients about the barriers that they encounter, at the time of
seeking care, in relation to post-discharge SSI have not been measured adequately. The
researchers conducted surveys and semi-structured interviews and found that some of the major
challenges that act as impediment in management of post-discharge surgical wound
complications encompass lack of adequate knowledge for wound nursing, absence of self-
efficacy for wound management at home, and lack of available communication with healthcare
providers. The researchers further elaborated on the fact that mHealth wound monitoring
application was considered extremely acceptable by the patients, and pronounced its potential to
deliver more recurrent, thorough, and expedient follow-up for wound monitoring. In addition, the
mHealth wound monitoring application was also found to lower post-discharge anxiety, when
compared to the existing practice. However, some of the major concerns related to mHealth
wound monitoring were inaccessibility of device and absence of timely response from the
healthcare providers.
In the words of Gunter et al. (2016) surgical patients are progressively spending their time in the
usage of mHealth platforms, with the aim of monitoring wound recovery, while communicating
with the healthcare providers during post-discharge period. Notwithstanding the extensive
eagerness for mHealth, lack of studies on user experience made the researchers explore the
patient usability of an image-based mHealth software for post-operative wound monitoring. The
researchers found that mean time spent by patients in training session and application completion
was 4.7 (2.1-12.8) minutes and 5.0 (1.4-16.6) minutes, respectively. Besides high user
satisfaction of 83.3 out of 100, 55.5% patients independently completed the application, with
maximum difficulty encountered at the time of taking digital imageries of surgical wounds. The
findings therefore, suggested that using a smartphone application increased satisfaction among
patients, in relation to their wound monitoring.
It has been established by Armstrong, Coyte, Brown, Beber and Semple (2017) that patients who
are subjected to ambulatory surgery can often follow-up their care through the use of mobile
health application, in comparison to conventional and in-person visits after their surgeries. They
conducted a randomised trial among 65 patients and found that patients who used the mobile

A MOBILE HEALTH SOLUTION TO IMPROVE SURGERY OUTCOME
application were able to attend 0.66 in-person visits, in comparison 1.64 in-person visits that
were found among patients who attended in-person follow-up care regimen. In addition, patients
who used the mHealth application were found to send more emails to health care professionals
during the first 30 days following the surgery (mean, 0.65 vs 0.15; incidence rate ratio, 4.13;
95% CI, 1.55-10.99; P = .005), when compared in-person patient follow-up group. The benefits
of mHealth outcomes were also demonstrated by Symer, Abelson, Milsom, McClure and Yeo
(2017) who conducted a pilot study of a novel mHealth application among patients who were
subjected to major abdominal surgery. The researchers conducted the study amid 31 patients and
found that an estimated 83.9% patients were able to complete an application-associated task, for
minimum 70% of the time. Furthermore, 89% patients suggested that the mHealth application
was considerably easy to monitor health outcomes. Besides, 1.1 alerts were generated on an
average by the patients, and most often the patients were able to complete the single-item
photoaffective meter. This findings also suggested that use of mHealth application demonstrated
the potential to improve health outcomes among patients who underwent abdominal surgery.
It has also been suggested by Jaensson, Dahlberg and Nilsson (2018) females often display an
increased likelihood of manifesting poor recovery after anaesthesia, when compared to males.
The findings suggested that females aged less than 45 years reported suggestively high global
scores, in relation to SwQoR questionnaire, concomitant with poor recovery during 1-10 post-
operative days, when compared to females aged more than 45 years or older (P=.001 to P=.008).
In contrast, males aged less than 45 years demonstrated high scores during 2-6 postoperative
days, in comparison to those aged more (P=.001 to P=.006). Thus, the research findings
provided evidence for sex resemblances in postoperative recovery amid male and female patients
who were subjected to mHealth follow-up.
Wang et al. (2018) also confirmed the above findings by conducting a randomised controlled
trial to determine the impacts of a mobile healthcare application on the health outcomes of
patients who had been discharged after a stoma. The researchers found that stoma self‐efficacy
score and psychosocial adjustment amid patients who were subjected to home care through a
mobile application were meaningfully greater than the control group during follow‐up (p < 0.05).
Furthermore, the results also indicated that stoma complications reduced amid patients who used
the mobile application. This in turn provided evidence for the fact that home care mobile
application acts in the form of an effective intervention, for supporting the self-efficacy and
emotional adjustment of stoma patients, following their discharge. In other words, mHealth
applications help in ensuring continuity of care, in addition to delivering guidance to the patients
in a timely manner. DeAntonio et al. (2019) also presented findings that are in accordance to
those presented above. The researchers tried to explore the application of a handheld
telemedicine (TM) device amid pediatric surgical patients and found that there were no
differences to the TM care plan, after missed diagnoses, “in person” evaluations, additional
clinic visits, or visits to the emergency department among those who had been subjected to only
TM postoperative evaluations. However, most of the patients reported extreme satisfaction and