Available online at www.sciencedirect.com ScienceDirect Procedia Computer Science 98 (2016 ) 388 393 The 6th International Conference on Current and Future Trends of Information and Communication Technologies in Healthcare (ICTH 2016) The DAPHNE Project Tatiana Silva a, Ángel Palomares Pérez b, Javier Andrés Calvo c, Gonzalo Bailador c, Giulia Cinelli d, Olga Kudrautseva e, Lobstein T f, Alberto Olmo a * for the DAPHNE Project Consortium a Treelogic SL, E28050 Madrid, Spain b ATOS SE, 28037 Madrid, Spain c Technical University of Madrid, 28223 Madrid, Spain d Bambino Gesù Pediatric Hospital, I-00146 Rome, Italy e SilverCloud Health, Dublin 8, Ireland f World Obesity Federation, London, UK Abstract This paper summarizes the DAPHNE Project presented at the ICTH 2016. The DAPHNE (Data-as-a-Service Platform for Healthy lifestyle and preventive medicine) Project is supported by the European Community s FP7 research programme with the objective of providing personalized ICT services to support healthier lifestyles for patients with obesity and related chronic diseases. The DAPHNE Project has developed wearable sensors to monitor health behavior, with data aggregated and transmitted to a cloud-based platform where it can be accessed by health care professionals to provide off-site monitoring and clinical care. 2016 Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). 2016 The Authors. Published by Elsevier B.V. Peer-review under responsibility of of the the Program Conference Chairs Program Chairs. Keywords: lifestyle; obesity; wearable devices; sensors; cloud platform; patient data; 1. Introduction The prevalence of overweight and obesity across Europe is high: more than 50% of the total European adult population are overweight (BMI>25) and in several Member States more than 20% of adults are obese (BMI>30) 1. Overweight and obesity contribute to mortality and the burden of major chronic diseases, such as cardiovascular * Corresponding author. Tel.: +34 910 05 90 88. E-mail address: alberto.olmo@treelogic.com 1877-0509 2016 Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer-review under responsibility of the Program Chairs doi:10.1016/j.procs.2016.09.059
Tatiana Silva et al. / Procedia Computer Science 98 ( 2016 ) 388 393 389 diseases (coronary heart disease, hypertension, and stroke), various types of cancer (endometrial, cervical, ovarian, prostate, breast, colon, rectal, kidney, liver and gall bladder), type 2 diabetes, osteoarthritis, reproductive disorders, sexual dysfunction, complications in pregnancy, as well as psychological and social problems 2. Data from several studies suggest that childhood obesity has also increased steadily in Europe over the past three decades. In Europe, almost 20% of children are overweight or obese, with some of the highest prevalence levels observed in southern European countries 3. The drivers of obesity include low levels of physical activity, high levels of sedentary behavior and unhealthy dietary intake, and these factors offer potential opportunities for prevention 4. The production of healthy lifestyles and prevention of obesity will lead to a reduction of costs to the European health care system, increased productivity in the labour force and improved household incomes for the individual and their families 5. The DAPHNE project (www.daphne-fp7.eu) was developed in response to the call for proposals on the use of ICT in health services to support personalized health, active ageing and independent living. The objective of the DAPHNE project is to develop a state-of-the-art ICT platform for reducing sedentariness and improving dietary habits, based on data-as-a-service and providing the necessary organizational, security and business models for the exploitation of the DAPHNE project results. The three-year development project runs 2013 through 2016 and, at the time of the ICTH 2016 symposium, the project can report on the development of personalized sensors, models and services, and the pilot-testing of the system in clinical environments with adult and adolescent patients. 2. The DAPHNE model The DAPHNE platform is designed to deliver personalized guidance services for lifestyle management to the individual citizen or patient by means of (i) advanced sensors and mobile phones to acquire and store data on lifestyle aspects, behavior and surrounding environment, (ii) individual models to monitor their health and fitness status, (iii) intelligent data processing for the recognition of behavioural trends and (iv) specific services for personalized guidance on healthy lifestyle and disease prevention. The intention is to ensure the DAPHNE platform will be open to hardware and software developers, providing data for different personalised health services, both at the citizen and service provider side. At the same time, data generated by end-users will be available in an anonymous and secure way for other stakeholders, like health insurance companies, public/private health companies, research, etc. which will be able to use it for orientation in their business. The paradigm Data-as-a-Service, as an evolution of Software-as-a-Service, will be used for data publication and consumption, taking into account relevant security and anonymity aspects, and enabling new business ecosystems and models that will be fully exploited before and after the finalization of the project. Data are being made available in a Data-as-a-Service platform, taking into account security issues, enabling integrated data exchange for key stakeholders to empower a high-performance population health management ecosystem. These data will be available for different types of consumption: a) Individual s input data for clinical use, meant for personal guidance and coaching, that can assist the doctors in their work and help in the patient co-production of health. b) A global big data source, for different stakeholders that could use global market data for clinical research or for orientation in their businesses. Figure 1 (below) shows the overall conceptual model, indicating the collection of information on body movement and body position, dietary intake, and physiological activity from the individual, the integration of this data using intelligent systems and algorithms to provide estimates of health-related behaviors, the transmission of this to cloudbased platforms where it can be made available to health professionals, and where it can be anonymized in order to
390 Tatiana Silva et al. / Procedia Computer Science 98 ( 2016 ) 388 393 provide Big Data for market applications and services, including health service providers, insurers, pension providers and actuaries. For data being used in clinical environments, specific sections of the platform need to be kept within the precincts of the health service provider (e.g. hospital) to ensure data security for patients under a physician s care. 3. Modules under development Fig. 1. The DAPHNE general model A complete user centric approach has been followed from the initial stages of the project, taking into consideration the opinion and experience of patients, physicians and caregivers. Testing of the technology has been addressed in different cycles, from initial technical testing to final clinical pilot-testing with adult and adolescent patients. Figure 1 shows the main modules developed in the DAPHNE project: Sensor devices and aggregator app for the connection to Daphne Data Cloud Daphne Data Cloud and Data analytic services Daphne interfaces for physicians (Physician Application), patients / caregivers (Personal Health System portal) Daphne Data consumer portal 3.1. Sensors and aggregator app The sensor device is one of several main innovations of the DAPHNE project. The sensor device has been developed by the Dutch company Evalan, and it takes the implementation of sensor and communication technology into new areas, specifically because it combines many functions (measuring and classifying body posture, physical activity, heart rate and galvanic skin responses) within a very small device, and because it streams raw measurement data at a very high data rate over Bluetooth. There is no wearable sensor available in the market at the moment that is equivalent to the sensor device. The sensor can be worn on the wrist or hip (or both locations for a higher level of data gathering) and it has
Tatiana Silva et al. / Procedia Computer Science 98 ( 2016 ) 388 393 391 incorporated advanced algorithms for the detection of different activities (such as running, walking, lying or sitting), and estimating energy expenditure. The sensor has been given CE certification in 2016 for use in clinical environments. An aggregator app has also been developed for the connection of the sensor with the DAPHNE Data Cloud, allowing interoperability with other Continua Alliance physical activity sensors. Additional information (including dietary information) is provided by the individual through app-based user interfaces on smartphones or home computers (see below). 3.2. DAPHNE Platform The DAPHNE platform is composed of the following modules: The information collected through the sensors and aggregator app, the nutritional information (via mobile and web interfaces, connected to the EUROFIR nutrient database (http://www.eurofir.org/)) along with psychological information (through standardized questionnaires, via mobile and web interfaces). The Personal Health System (PHS) portal, which is the access point for patients and caregivers, and consists of a web application where these users can check and see their information in the platform as well as the personalized recommendations that DAPHNE generates after processing the user s health parameters. In order to facilitate the usability of DAPHNE s platform by users, and provide the needed data insertion, there are some PHS services based on mobile applications. These applications allow users to introduce information (or consume it) in the system by using their mobile devices. The Physician Application, which is a web portal designed to help physicians in the task of monitoring patients. In this portal the required information about the patient is centralized and available for facilitating analyses undertaken by the patient s physician or other health service professional. This tool provides options to control the data shown and the desired targets for the patient s physical activity, dietary goals along with coaching messages and reminders. For use outside the health services, a consumer portal or Professional Application can be developed which provides data to the individual s private professional trainer, dietician, sports coach, or for research purposes. 4. Pilot testing The DAPHNE platform is currently being clinically validated in two clinical settings: In the Ospedale Pediatrico Bambino Gesù, Italy, where the system is being used by adolescents with obesity problems, under the supervision of their parents and clinicians. In Maccabi Healthcare, Israel, where the system is being used by adults with obesity problems under clinical supervision. The following objectives are pursued in the clinical pilot tests: The degree of motivation of end users in the use of the DAPHNE platform The appropriateness of the collected parameters for the treatment of obesity from the physicians perspectives The first results are expected August 2016. 5. Security Safeguarding confidential patient information remains one of the biggest challenges for the adoption of cloud computing solutions in the healthcare industry 6. Different consumption of data will involve different security constraints, from its medical use (especially in the case of children), shared only between patient and doctor, to its use in research or for business intelligence, where only statistical and anonymous data will be provided. Horizontal services to the DAPHNE platform for ensuring these security requirements have been designed and
392 Tatiana Silva et al. / Procedia Computer Science 98 ( 2016 ) 388 393 developed, focusing on two main categories: (i) Privacy and Security Design for Public Data, and (ii) Privacy and Security Design for Private Data. In addition, aspects such us Authentication/Authorisation, Awareness and Auditory Management of the system will be studied in the different situations, finding the solution which suits best the project needs (such as Single Sign On (SSO) or Federated Identity). DAPHNE project consortium members including ATOS, Nevet and IBM have designed solutions able to deliver horizontal services across the whole DAPHNE System. 6. Exploitation The research conducted within the DAPHNE project indicates that despite of the growing popularity and uptake of the self-monitoring technology including wireless sensor devices or mobile applications for tracking food, sleep or heart rate, there is still a lack of understanding and empirical data confirming their benefits and meaningful impact on the individuals who are trying to lose weight 7,8. Healthcare professionals need guidance on best practices and care models to use the technology, while facing a lack of clear legal frameworks for regulating and managing the data generated by the sensor devices or mobile application. One of the aims of the DAPHNE project is to develop recommendations for shaping the best practices and technology-based care models enabling an effective weight loss care in clinical practice, built upon the lessons learned during the DAPHNE pilot studies, while acknowledging already-existing commercial products. These products adopt an ICT care model similar to the DAPHNE and have claimed very successful long term weight loss outcomes: 97% engagement rate, 88 % participants who lose weight and 81 % who have maintained weight loss over the long term 9. 7. Conclusions The DAPHNE project aims to provide personalized ICT services for the prevention of overweight and obesity, using new technical developments in wearable sensors, software apps, biometric algorithms and cloud-based data servicing. The objective is to supply additional information to clinicians and greater motivation to patients in the improvement of healthy lifestyle behaviors. In contrast to personalized devices on the market generally, the DAPHNE project tackles the obesity problem from a clinical point of view, designing the different interfaces for its use by patients (adults and children), physicians and caregivers. Interoperability with existing medical systems and clinical standards has been taken into account, raising the potential for its deployment in public and private hospitals in Europe and worldwide. Acknowledgements The DAPHNE Project is co-funded by the European Union Seventh Framework Programme under grant agreement no 610440. Sole responsibility for the project lies with the participating organisations; the European Commission is not responsible for the use that may be made of any material arising from this project. DAPHNE Project Consortium Treelogic (Spain), IBM (Israel), Atos (Spain), University of Leeds (UK ), Evalan (The Netherlands), Ospedale Pediatrico Bambino Gesù (Italy), Universidad Politecnica de Madrid (Spain), SilverCloud (Ireland), World Obesity Federation (UK), Nevet (Israel). References 1. World Health Organization. The European Health Report 2015.Copenhagen: WHO Regional Office for Europe, 2015. 2. Public Health England. Health risks of adult obesity. UK Government website. URL: http://www.noo.org.uk/noo_about_obesity/obesity_and_health/health_risk_adult (accessed 24 June 2016). 3. Currie C, Zanotti C, Morgan A et al., eds. Social determinants of health and well-being among young people. Health Behaviour in School-aged Children (HBSC) study: international report from the 2009/2010 survey. Copenhagen, WHO Regional Office for Europe, 2012 (Health Policy for Children and Adolescents, No. 6).
Tatiana Silva et al. / Procedia Computer Science 98 ( 2016 ) 388 393 393 4. Chan RS, Woo J. Prevention of overweight and obesity: how effective is the current public health approach? Int J Environ Res Public Health, 2010;7:765 783. 5. Loring B, Robertson A. Obesity and inequities- Guidance for addressing inequities in overweight and obesity. Copenhagen: WHO Regional Office for Europe, 2014. 6. Directorate General for Health and Food Safety. Overview of the national laws on electronic health records in the EU Member States. European Commission website, URL: http://ec.europa.eu/health/ehealth/projects/nationallaws_electronichealthrecords_en.htm (accessed 24 June 2016). 7. Oh B, Cho B, Han MK et al. The Effectiveness of Mobile Phone-Based Care for Weight Control in Metabolic Syndrome Patients: Randomized Controlled Trial. JMIR Mhealth Uhealth. 2015;3:e83. 8. Franklin NC, Lavie CJ, Arena RA. Personal health technology: A new era in cardiovascular disease prevention. Postgrad Med. 2015;127:150-158. 9. Retrofit Inc. BMI changes, activity, lifestyle patterns, and engagement metrics in real-time. Chicago, Il: Retrofit, 2016. Company website, URL: https://www.retrofitme.com/employers/ (accessed 24 June 2016).