Dissertations / Theses on the topic 'EHealth technologies'

The increased implementation of digital health technologies requires a better understanding of how to design technologies and services that enhance people's engagement with their health. This thesis contributes new knowledge about i) an increased understanding of the different ways in which people engage with digital health technologies, ii) the stages of people's engagement with digital health technologies over time, and iii) the features that support such engagement. The findings offer new directions for the digital health industry to further develop their service design. They also support people's engagement with their health goals through tailoring their services more effectively to end-users.

As a response to the need for efficiency and innovation that modern society hasplaced over healthcare organizations, they are constantly looking for more efficientand innovative tools that facilitate the daily practices for providers. In this context,the use of digital solutions or eHealth arises as an alternative for healthcare.Despite the potential benefits of eHealth solutions, healthcare leaders experiencedifficulties implementing them. For that reason, health services researchersacknowledge the critical role of implementation science in the sector. Seeking tomotivate organizations to embrace eHealth solutions and their benefits, thisresearch identifies the barriers and facilitators experienced by project managersduring the implementation projects of innovations in healthcare. Moreover, itproposes the clarification of concrete criteria to assess success derived from theoutcomes of an implementation project. Starting with a literature review, followedby qualitative research and a data collection through a total of ten semi-structuredinterviews with project managers. Moreover, the data analysis is made based onthematic analysis. The results identify three main facilitators for innovation: 1)maintaining a balanced level of understanding for all stakeholders, 2) to have opencommunication, and 3) to have a high involvement of the top management with theproject. Moreover, the most relevant barrier faced by managers is the lack of skilledand competent people within the organization. Regarding the success ofimplementation projects, the most relevant criteria are: 1) delivering in the righttime, budget, scope and quality (reach the project goals), 2) maintaining thecustomer and user satisfaction, and 3) increase in work efficiency in the healthcareorganizations. To some extent, the mentioned factors contribute to facilitating theimplementation of innovations in healthcare. The role of managers inimplementation is highly valuable since they represent the bridge between topmanagement and front-line employees. This research summarizes the experienceof the managers -from a consultancy company- while working in theimplementation of digital tools in healthcare. Therefore, the research provides abetter understanding regarding the barriers, facilitators and success criteria forimplementation.

Pregnancy is a sensitive period in women’s lives; pregnant women encounter various physical changes and emotional challenges during pregnancy. The vision for Sweden’s eHealth initiative is to be the best in the world in using eHealth to make it easier for people to achieve a healthy wellbeing and equal welfare by 2025. However, there is a lack of empirical studies in the area, especially studies associated with both eHealth and pregnancy in a Swedish context. Therefore, the thesis intended to seek the factors that affect a pregnant woman to adopt an eHealth innovation by applying qualitative interviews. Eleven women were selected including both women who are currently pregnant and women who have experienced pregnancy in recent years. Semi-structed interviews were chosen to gain more in-depth insights of the challenges during pregnancy. The data analysis followed the framework of Unified theory of acceptance and use of technology (UTAUT). Rogers’ innovation diffusion theory was discussed in relation to the study as well. The results based on the date from the study showed that the real drive for pregnant women to adopt an eHealth innovation is the dissatisfaction with the current solution, namely prenatal care in the Swedish public health care system. Other moderating factors that affect their intention for adoption are relevant knowledge, expertise support and trialability. The results revealed that women with foreign background were more likely to be dissatisfied with prenatal care in Sweden, and that professionals’ involvement in using the innovation and the possibility of experimenting with it will increase the intention of innovation adoption. Age, experience, and personality were not supported in having an impact on innovation adoption in this study. The limitations of the study are transferability and confirmability, where credibility, dependability and authenticity are high in this study.

L'introduction des technologies de l'information et de la communication (TIC) dans la relation de soins est une déclinaison d'un mouvement plus global, tendant à la construction d'une véritable société de l'information. Si le secteur de la santé n'est pas épargné par ces usages nouveaux, il mérite néanmoins une étude particulière tant le colloque dit singulier, entre le médecin et son patient, est empreint de singularité. La télémédecine, en tant que pratique médicale à distance, s'illustre par son ancienneté, et la nouveauté de son cadre normatif. D'abord, offrant une mutation spatiale et temporelle de l'exercice médical, les TIC déplacent les frontières traditionnelles, et celles notamment reconnues à l'auteur et à la finalité de l'acte médical. Le colloque devient pluriel et dématérialisé. Ensuite, les enjeux du recours aux TIC, nouvel écran technique, ont rendu impérieux l'intervention du droit, afin qu'il encadre et en régule l'usage. Le droit de la relation de soins recourant aux TIC est protéiforme. Les droits et devoirs des médecins et des patients s'appliquent invariablement à cette nouvelle forme de pratique médicale. Mais, le législateur a tenté d'étoffer ce cadre en initiant des règles dédiées, parcellaires et lacunaires. Le recours aux autres branches du droit est nécessaire au dessein d'un encadrement global. Il démontre pourtant son insuffisance ou son inadaptation à une activité si singulière
The introduction of information and communication technologies (ICT) in the caring relationship is part of a wider movement, aiming at building a real society of information. Although public health is not spared from those new customs, it nevertheless deserves its own specific study, given the singularity imprinted by patient-doctor relationships. Telemedicine, as a distant medical practice, is characterized by its seniority and the novelty of its normative frame. First of all, offering a spatio-temporal mutation of the medical practice, TIC shift traditional boundaries, including those recognized to the author and finality of the medical act. The doctor-patient bond becomes plural and dematerialized. Then, challenges implied by the resort to TIC, this new technical screen, made very imperious the intervention of the law to supervise and control its use. Caring relationship law resorting to TIC is protean. Doctors and patients' rights and duties invariably apply to this new form of medical practice. However, the lawmaker tried to fill this frame out by initiating dedicated rules, yet remaining piecemeal and lacunar. Resorting to the other fields of law is needed with view to a wide supervision. It however demonstrates its failure or unsuitability for such singular activity

Tese de Doutoramento em Ciências Sociais na especialidade de Administração Pública
Os Hospitais Públicos têm adoptado inovações a vários níveis. Os Serviços de Saúde merecem atenção dos Governos e da Sociedade, assumindo as Tecnologias de Informação e Comunicação (eHealth) um papel importante. Espera-se que as soluções eHealth tragam mais eficácia e surjam inovações tecnológicas permitindo uma atitude de maior prevenção e uma gestão mais eficaz. Nos Hospitais Públicos decide-se sobre o uso de soluções eHealth. Procurámos conhecer os factores influenciadores dessas decisões, em Portugal (1996-2007). Isso contribuirá para confirmar as abordagens de adopção do eHealth e motivará investigação sobre a utilização das TIC no ecossistema da Saúde em Portugal, em comparação com outros países. Desenvolvemos uma tipologia de 16 categorias e um modelo de análise com 10 factores influentes nos processos decisórios; construímos um documento para recolha de informação dos responsáveis por estas decisões; visitámos quinze Hospitais Públicos; recolhemos e analisámos as respostas. Conclusões: as decisões sobre a adopção de eHealth são influenciadas por factores internos: dimensão do hospital, orientação para a qualidade na prestação dos serviços de saúde, descentralização da gestão e preparação dos profissionais para as novas soluções; os factores externos têm tido uma influência reduzida; a influência dos diversos factores depende da especificidade da categoria de soluções eHealth.
Public Hospitals have adopted innovations in several respects. Health Services deserve attention from Governments and Society. Information and Communication Technologies in Health (eHealth) are important. One hopes that eHealth solutions will bring greater efficacy and quality to health services and that technological innovations will allow a better attitude towards disease and more effective management of resources. In Public Hospitals decisions are being made for the use of eHealth solutions. Present research aimed to increase knowledge about the factors that influenced such decisions in Public Hospitals in Portugal, 1996-2007. This may contribute to confirm the approaches to the adoption of eHealth in Public Hospitals and to foster research on ICT impact in the Health ecosystem in Portugal, as compared to other countries. We have developed a typology of 16 categories of eHealth solutions and an analysis model with 10 factors that influence decision making; we set up a document to collect information and visited fifteen Public Hospitals collecting and analyzing the results. Conclusions: decisions are influenced mainly by internal factors: size of the hospital, quality trend, decentralization of management, training of professionals; external factors have little influence; the influence of different factors varies according to the specific type of eHealth solutions.

This thesis has its starting point in the digitalization of society focusing on the rapid development of mobile technologies and the increasing interplay between humans and machines. The use of information and communication technologies (ICT) is extending at a fast pace, affecting all parts of society, and the everyday life of most individuals. The fast progressing development of mobile technologies (smartphones and their accessories/ wearable’s) is creating new trends such as health tracking and quantified self. These mobile technologies can register an increasing number of physiological features, implying that the interconnection between the physiological and digital systems is increasing. This creates a range of new possibilities within health and medical research but it also creates new challenges and the need for new knowledge in how we relate these devices to our bodies. In the psychological perspective, smartphone use is increasing and previous studies imply that these devices are affecting our behaviour, our mental health as well as our cognitive functions. This implies for a need to understand the relation we have to these devices also in a psychological perspective, focusing on emotions and cognition. This study set out to explore the relation between humans and technologies from a systems perspective. The research question involved: How are users and smartphones related in physical and psychological perspectives? The methods used were questionnaires and interviews. The respondents were students in two European universities, who described their experiences of smartphone use, and three doctors (in medicine and biomedicine) that provided interesting aspects in how mobile technologies can be related to the human body from a system perspective   In a physical perspective the users as well as their physical environments could be described as converging with the digital systems. The need of being connected and have access to all life-spheres at once seemed to be an important driving force, implying that users are dependent on information and a converged life-style. In a psychological perspective, the emotional bond seemed stronger then the actual physical need. The perceptions of smartphones differed, but a common denominator described by both Swedish and Albanian users, was the perception of the smartphone as something with human-like features, comparable to a friend. The last part of the study concerned if smartphones can be seen as a new entity of our own system, comparable to an organ. The result suggests that this depends on the individual use, if the technologies is used to sustain health, the value it provides, and it is also a matter of the users ontological believes. The concept of physio-digital convergence is proposed as a new concept to analyse the development of increasing use of mobile technologies further.

L’utilisation des TIC à l’hôpital prend une place de plus en plus importante et son développement ne cesse de croître. Le cadre juridique applicable se révèle cependant complexe à appréhender, composé à la fois de textes de droit commun et de textes plus spécifiques, le tout formant un ensemble pas toujours cohérent. Pour accompagner au mieux l’utilisation des TIC à l’hôpital, le législateur doit trouver le juste équilibre entre cadre propice pour le développement de ces pratiques, protection des droits fondamentaux et sécurisation des pratiques. Or, à l’heure actuelle, le cadre juridique applicable à l’utilisation des TIC à l’hôpital ne permet pas d’assurer cet équilibre délicat. Les pouvoirs publics ont donc un rôle stratégique à jouer dans la sécurisation de l’utilisation des TIC à l’hôpital. Une impulsion nationale doit être donnée en la matière, afin d’assurer la cohérence des projets développés, au travers d’une gouvernance forte. Le cadre juridique doit, quant à lui, être rénové afin d’accompagner l’innovation dans le numérique en santé et assurer la sécurité juridique nécessaire à la bonne utilisation des TIC. Dans ce contexte, les hôpitaux ont un rôle essentiel à jouer afin de sécuriser leurs pratiques
The use of ICT has become increasingly important in hospitals. However, the legal framework structuring its use is very complex to grasp. Indeed, it is made up of general laws as well as specific ones and makes this framework sometimes unconsistent. To provide an optimal legal framework for the ICT to expand safely, the legislator needs to strike the right balance between protecting fundamental rights and securing practices. As the current legal framework does not provide this delicate balance, public authorities have a strategic role to play to ensure a secure use of ICT within hospitals. To guarantee the development of consistent projects, a strong governance has to set up a national leadership. The legal framework needs to be rehabilitated to support digital innovation in Healthcare and to ensure a legal protection required for an appropriate use of ICT. Hospitals have then a key role to play in securing their practices

Digital transformation is evolving, and it is driving at the helm of the digital evolution. The amount of information accessible to us has revolutionized the way we gather information. Mobile technology and the immediate and ubiquitous access to information has changed how we engage with services including healthcare. Digital technology and digital transformation have afforded people the ability to self-manage in different ways than face-to-face and paper-based methods through different technologies. This study focuses on exploring the use of the most commonly used digital health technologies in the healthcare sector and how it affects physicians’ daily routine practice. The study presents findings from a qualitative methodology involving semi-structured, personal interviews with physicians from Sweden and a physician from Spain. The interviews capture what physicians feel towards digital transformation, digital health technologies and how it affects their work. In a field where a lack of information regarding how physicians work is affected by digital health technologies, this study reveals a general aspect of how reality looks for physicians. A new way of conducting medicine and the changed role of the physician is presented along with the societal implications for physicians and the healthcare sector. The findings demonstrate that physicians’ role, work and the digital transformation in healthcare on a societal level are important in shaping the future for the healthcare industry and the role of the physician in this future.
Den digitala transformationen växer och den drivs vid rodret för den digitala utvecklingen. Mängden information som är tillgänglig för oss har revolutionerat hur vi samlar in information. Mobila tekniker och den omedelbara och allmänt förekommande tillgången till information har förändrat hur vi tillhandahåller oss tjänster inklusive inom vården. Digital teknik och digital transformation har gett människor möjlighet att kontrollera sig själv och sin egen hälsa på olika sätt än ansikte mot ansikte och pappersbaserade metoder genom olika tekniker. Denna studie fokuserar på att utforska användningen av de vanligaste digitala hälsoteknologierna inom hälso- och sjukvårdssektorn och hur det påverkar läkarnas dagliga rutin. Studien presenterar resultat från en kvalitativ metod som involverar semistrukturerade, personliga intervjuer med läkare från Sverige och en läkare från Spanien. Intervjuerna fångar vad läkare tycker om digital transformation, digital hälsoteknik och hur det påverkar deras arbete. I ett fält där brist på information om hur läkare arbetar påverkas av digital hälsoteknik avslöjar denna studie en allmän aspekt av hur verkligheten ser ut för läkare. Ett nytt sätt att bedriva medicin och läkarens förändrade roll presenteras tillsammans med de samhälleliga konsekvenserna för läkare och vårdsektorn. Resultaten visar att läkarnas roll, arbete och den digitala transformationen inom hälso- och sjukvården på samhällsnivå är viktiga för att utforma framtiden för vårdindustrin och läkarens roll i framtiden.

Personer som lider av migrän har i de flesta fall någon gång funderat över vad som är den utlösande faktorn. Ibland vet de svaret, ibland är svaret inte lika tydligt. Att ha kunskap och förståelse över sin migrän kan öka chanserna till självhjälp och ökad empowerment. Patienterna har tillräcklig kunskap för att kunna ta beslut som bidra till en bättre hälsa för individen. Patienten hjälper således sig själv till ett bättre välmående utifrån den kunskap som patienten har om sig själv och sin sjukdom. För att skapa en förståelse och större kunskap för sin sjukdom kan det underlätta att dokumentera sina migränanfall. Dokumentationen kan sedan användas för att hitta en gemensam nämnare till anfallen. Att dokumentera migränanfall kan också kallas för att föra en migrändagbok. Migrändagböcker kan ordineras ut av hälso- och sjukvård i form av enklare dokumentation på pappersark. Det finns också digitala lösningar där personer som lider av migrän kan dokumentera in mer utförliga uppgifter om sin migränattack via olika migränappar som finns att ladda ner. En digital lösning ger större möjlighet till en rikare information om personens sjukdom, men saknar ofta anpassning för migränpatienters särskilda behov och upplevda problematik. Personer som lider av migrän kan uppleva problematik med att interagera med digitala skärmar. Att interagera med skärmar kan vara en bidragande orsak till ett sämre mående, vilket framkom i denna undersökning. Syftet med denna studie var att undersöka hur ett gränssnitt för en mobil hälsoapplikation för migränpatienter kunde utformas med fokus på empowerment och god användarupplevelse. För att ta reda på detta, genomfördes 7 stycken semistrukturerade intervjuer. Informanterna fick berätta om sina upplevelse av migrän, deras egen kunskap om sin sjukdom, samt tekniska aspekter om hur de vill interagera med mobilappar under tiden som de har migrän. Den data som uppkom utifrån intervjuerna analyserades sedan med hjälp av kvalitativ kodning som resulterade i fyra olika teman. Behovet visar att dokumentation av migränanfall genom mobilapplikationer ska ske med så lite interaktionstid med skärmen som möjligt. Dokumentation av migränanfall kan med fördel ske med hjälp av tal och ljud. Själva gränssnittet ska vara enkelt och simpelt med avskalade ikoner som tydligt ska gå att identifiera. Det ska finnas möjlighet att manuellt eller med automatiska inställningar dämpa ljuset på skärmen. Resultatet av undersökningen mynnade sedan ut i lämpliga gränssnittsförslag i form av mockuper. För framtida forskning rekommenderas att utföra användartester med utökade prototyper, för att undersöka huruvida de designförslag som tagits fram i denna studie upplevs som en god användarupplevelse och bidrar till empowerment.
People who suffer from migraines have probably at some point thought about what the triggering factor is. Sometimes the answer is clear, and sometimes it’s not that obvious. To have understanding and knowledge of their migraine can increase the chances of self-help and also higher levels of empowerment. With self-help, the patient can make better decisions based on the knowledge of the disease, which can lead to a better well-being. In order to establish an understanding and more knowledge about their illness, it can be helpful to document the migraine attacks. The documentation can then be used to find a possible cause of the attacks. This is also called a migraine journal. Migraine journals can be prescribed by the health services, where you get a template with less words and with simple instructions of the tasks on them. There are also digital solutions, like mobile applications, that supports more detailed documentation. A digital solution provides more opportunities for more detailed information about the person's illness, but mobile apps often lacks adaption for the patient's specific needs and problems. Persons who suffers from a migraine attack, can experience difficulties when documenting a large amount of information on applications. The interaction with digital screens may worsen the symptom. This is one of the findings of this study. The purpose of this study was to examine how a user interface for a mobile health application, could be designed with focus of empowerment and a good user experience. To find out, 7 semi structured interviews were conducted. The informants were asked to tell about their experiences, their knowledge about their illness and some technical aspects of how they want to interact with mobile applications while they are suffering from an attack. The data that was obtained from the interviews were then analyzed using qualitative coding that resulted in four different themes. The study showed that the potential users wish to interact as little as possible with the screen. Documentation of migraine attacks can be done with the help of speech and sound. The interface itself should be easy with simple icons which are easy to identify. It should be possible to manually or automatically adjust the light on the screen. The result of the study contributed to suggestions for how to design a suitable interface for migraine patients. The interface is visualised in this report in the form of mockups. For future research , it is recommended to perform user tests with extended prototypes to investigate whether the design principles and design suggestions developed in this study are perceived as a good user experience and contribute to empowerment.

INTRODUCTION The pressure to contain health costs, particularly by avoiding hospitalizations and promoting the early discharge of patients, is generating a greater demand for home healthcare at a time when this resource is rapidly becoming less available. Telemedicine has been defined as the use of information and communications technologies (ICT), to deliver health services and transmit health information at distance for the purpose of improving patient’s care and education and to facilitate communication between patients and healthcare professionals. Most of the studies on telemedicine showed a lot of potentialities and possibilities, but did not develop further in the clinical routine because of problems and difficulties involving the use of this technology. Therefore, it seems clear the need of simple and straightforward applications, which can provide useful and widely applicable services to healthcare and as well as reliable data to assess the actual impact of telemedicine on homecare. 2) GENERAL AIM To design, develop, validate and assess the benefit of new Information and Communication Technology (ICT) applications in healthcare at patient’s home. 3) HYPOTHESES 1. An Internet-based support system for monitoring newborn patients after discharge from nursery would improve care, be well accepted by parents and reduce unplanned healthcare, particularly visits to the emergency department; 2. The development of a specific web-based tool could introduce a new strategy for the continuous positive airway pressure (CPAP) therapy follow-up of patients with obstructive sleep apnea syndrome (OSAS), which could improve the CPAP compliance, reduce face-to-face clinical visits, and be more cost-effective; 3. A new telemedicine system for remote CPAP therapy monitoring could provide valuable and useful data about treatment compliance and efficacy for the follow-up of OSAS patients. 4) STUDY 1 - A new Internet-based monitoring tool for the neonatal home care after discharge was successfully developed; - This new monitoring approach resulted in a high level of parental satisfaction with the service; - Using a societal perspective, the cost of the Internet-based follow-up resulted much lower than that of the conventional hospital-based follow-up. Additionally, ED visits in the first month of patients’ life decreased with the use of the Internet-based monitoring system. This telemedicine follow-up strategy proved absolute dominance (both more clinically effective and less costly) over the standard follow-up based on hospital visits; - This Internet-based tool has been effectively transferred to the health system since it is in routine clinical use at the Hospital de Sant Pau in Barcelona (www.petitsacasa.santpau.cat). 5) STUDY 2 - The opinion of the interviewed patients and medical staff about the helpfulness and satisfaction of the telemedicine monitoring approach indicated that the web-based support tool together with the televisit are potentially useful to support the home follow-up of CPAP treatment in OSAS patients; - The high patients’ compliance to the remote monitoring through the online questionnaire suggested this strategy to be helpful and practical for the long-period CPAP therapy control; - The multicenter support system we developed represents a new telemedicine approach to CPAP therapy follow-up for OSAS patients, which seeks enforcing patients’ confidence and improving therapy adherence; - The developed telemedicine support system has been effectively transferred to the health system since it is in use in a multinational clinical trial currently involving 18 hospitals (www.mi-cpap.com). 6) STUDY 3 - The geometry of the telemonitoring device (NOWAPI) does not influence the CPAP treatment; - NOWAPI showed good compatibility with the CPAP machines and an excellent performance in estimating the duration of the CPAP treatment and in detecting residual respiratory events in simulated OSAS patients. The results of this study demonstrated that NOWAPI system could be a valuable tool for telemonitoring the treatment of obstructive sleep apnea;

Les technologies du sommeil connaissent une révolution numérique à laquelle nous avons apporté une validation avec pour objectif une meilleure analyse des troubles du sommeil en Unité de Soins Intensifs, dans la maladie d’Alzheimer et dans l’évaluation de l’hypovigilance en vol de longue durée en milieu militaire. Ainsi, nous avons évalué le temps de sommeil sur 24 heures en relation avec les nuisances sonores en soins intensifs. Cette évaluation a été réalisée à l’aide d’un nouveau polysomnographe l’Actiwave couplé à un polygraphe Nox T3 qui ont permis d’enregistrer les cycles du sommeil et les niveaux sonores sur les 24 heures dans une Unité de Soins Intensif. Nous avons montré que l’Actiwave est un outil performant pour enregistrer le sommeil dans de telles conditions. Combiné au Nox T3, il permet d’explorer l’impact des niveaux sonores sur la qualité et quantité du sommeil. Nous avons retrouvé un Temps Total de Sommeil médian de 6 heures par nuit et de 2,5 heures pendant la journée, la qualité de sommeil étant plus perturbée que sa quantité. Nous avons démontré que 60% des éveils intra-sommeil étaient associés à un bruit supérieur à 77 dB et identifié les sources sonores principales qui agissent sur la pathogénèse des troubles du sommeil en Unité de Soins Intensif, à savoir les alarmes des respirateurs mécaniques avec un risque relatif de 10.9 (9.8-11.9) et les alarmes des constantes vitales avec un risque relatif de 9.8 (8.6-11.3). Une deuxième étude, l’évaluation de l’hypovigilance en vol de longue durée, a été réalisée à l’aide de l’ActiWave. Pour cela, nos équipes ont conçu un algorithme d’analyse automatique de détection du sommeil. Nous avons montré que l’ActiWave est un polysomnographe fiable en conditions extrêmes, l’analyse automatique montrant une bonne concordance avec l’analyse manuelle de deux experts du sommeil (Kappa>80%). Nous démontrons donc qu’il est possible de coder automatiquement les stades de sommeil à l’aide du ratio (+)/ sur la région occipitale O1-M2 vs C3-M2 (p<0.05). Nous avons validé un nouvel actimètre le MotionWatch 8 pour l’évaluation du temps de sommeil chez 208 patients présentant la maladie d’Alzheimer. Ce travail a permis de montrer que le MotionWatch 8 est un outil fiable avec de bonnes sensibilité et spécificité dans l’évaluation des troubles du sommeil chez ces patients. Le Temps Total de Sommeil est dans la norme (TTS moyen 7h35 minutes) et est significativement associé au score d’apathie (7h46 minutes vs 7h26 minutes ; p=0.04). Le marqueur chrono-biologique SIJ est également associé à l’apathie (p=0.04) ainsi qu’aux troubles cognitifs (p=0.02). Finalement, la fragmentation de rythmes veille/sommeil (VIJ) est associée au score du handicap de la maladie d’Alzheimer (p=0.02). Dans une quatrième étude, nous nous sommes intéressés à la nouvelle technologie de télé-observance dans le traitement du syndrome d’apnées du sommeil par pression positive continue, qui permet d’alerter le médecin de la compliance du patient. Nous avons validé un nouveau dispositif médical de télé-observance du traitement du syndrome d’apnées du sommeil, le NOWAPI. Nous montrons que le NOWAPI mesure avec précision et de manière fiable les niveaux de pressions et de débits des PPC disponibles sur le marché et qu’il permet de calculer les indicateurs d'observance des patients souffrants du syndrome d’apnées du sommeil (IAH Nowapi de 2,5 (-1.4 ; 3.6)/h vs IAH Polygraphie respiratoire de 2,3 (1.2 ;3.4)/h). En conclusion, les études présentées ici mettent en exergue l’importance de l’innovation technologique dans le domaine du sommeil pour une meilleure prise en charge des patients. A l’ère du 21ème siècle, une nouvelle médecine commence à émerger, la médecine 2.0, avec pour corollaire l’eSanté. (...)
Scientific research into sleep over the past thirty years has progressed so speedily that it is now possible to speak of “Sleep Medicine”. This specialty is placed incontestably at the frontier of Science and Medicine. The issues have been recently driven by the advances in the technology of recording biological parameter and analysis of the data, in parallel with a deeper understanding of the physiopathology and therapeutic advances in sleep disorders. The subject of this thesis lies at the crossover of two areas of professional expertise; sleep technology and bio-engineering, with notably the aim of validating new tools in research as well as in the diagnosis and treatment of sleep disorders. We have tested a miniaturized polysomnographic new technology, the Actiwave, capable of detecting sleep and alert states in extreme conditions, notably in patients hospitalized in Intensive Care Units and in aircraft pilots in long duration military flights. In intensive care units, we have explored the relation between sleep and noise in the immediate environment of the patients. In brief, Total Sleep Time was not disturbed whereas the sleep quality was altered. Wake episodes after sleep onset were mostly associated with noise over 77 dB, and the main disturbances were triggered by the alarms of breathing machines and those from vital parameters. In military flights of long duration, we have explored the presence of hypovigilance episodes. This allowed us to validate the Actiwave for polysomnography in extreme conditions. In a third study, we have analyzed the sleep patterns in a total of 202 patients with Alzheimer’s disease by using a new actimeter, the MotionWatch8. We have shown that the latter device has a good sensitivity and specificity or evaluating sleep-wake parameters in these patients. In particular, we find that the TST is in the normal range and is associated with the aptathy score. The SIJ score is associated with the apathy score and also with the cognitive impairments. Finally, the sleep fragmentation is associated with the disability status. In a last study, we explored the parameter of sleep apneas in patients with SAS using the NOWAPI. We validated this new device by demonstrating that it provides on-line reliable data about pressure and flow levels of various CPAP. In conclusion, this thesis considers possible future avenues of research into sleep technology and discusses the crucial importance of a scientific approach capable of leading the development of appropriate and lasting diagnostic and therapeutic tools. The next step will be the era of the 2.0 medicine for which I am developing the iSommeil application that will allow patients to be the actual actors of their disease and also to facilitate the diagnostic and the prevention of sleep disorders

2017 became the beginning of the Childbirth Crisis of Sweden, as a result of underbudgeting and understaffing, creating an environment where patient safety and availability was questioned. Additionally, information and communication technology rapidly take a larger role in the field of healthcare, nourishing new solutions for old processes. This explorative research was conducted to answer how information and communication technologies, and communication techniques, are used and could be used to provide safe care for patients. This study was conducted with 10 participants working as medical staff at a Swedish neonatal care unit. The medical staff who participated consisted of registered nurses, certified pediatric nurses, pediatric nursing assistants, and one nursing assistant. The approach of this research was through system thinking in the tradition of soft systems thinking. The data collection was performed with a combination of semi-structured interviews and card sorting. The collected data were processed, organized, and interpreted with the three c’s of analysis and thematic analysis. The results of this study are complemented by rich pictures. The empirical findings of this study describe a neonatal care unit known at its hospital to be the one unit holding the largest number of different devices. The medical staff at the researched NCU are using information and communication technology in a combination together with specific communication techniques, to create an understanding of their patients’ conditions. The study connects a state of safe care to the training and knowledge of the information and communication technologies, and communication techniques used at the neonatal care unit. The combination of the information and communication technologies, and communication techniques used at the NCU are vital tools, conclusive to the medical staff when providing safe care for patients. This study provides an insight into one Swedish neonatal care unit, based on the interpretations of its medical staff.

Sulla base della teoria delle Comunità di Pratica e dell'Azione Situata, la ricerca si propone come scopo generale lo studio delle dinamiche interattive, relazionali e comunicative legate all’introduzione di una Cartella clinica medico-infermieristica informatizzata da parte di Comunità di Pratica professionali, composte da medici ed infermieri. Il primo obiettivo è quello di studiare in un’ottica psicosociale la creazione (primo studio) e il funzionamento (secondo studio) di Comunità di Pratica professionali nate intorno alle Nuove Tecnologie, tenendo conto anche se e in quale misura una comunità che segue un nuovo paradigma di interazione sociale possa essere considerata una vera e propria Comunità di Pratica. Il secondo obiettivo è quello di affinare una metodologia di indagine psicosociale in riferimento alle dinamiche che si concretizzano all’interno delle Comunità di Pratica, senza dimenticare la dimensione dell’Identità/Soggettività. I risultati, in un'ottica esplicativa di comprensione delle dinamiche sottostanti all’essere parte di una Comunità di Pratica o all’iniziare a farne parte, hanno restituito interessanti risvolti dal punto di vista interpersonale e organizzativo, con particolare riferimento alla costituzione e allo sviluppo delle due Comunità di Pratica e agli aspetti comunicativi e identitari della relazione medico-infermiere. Il terzo e ultimo obiettivo è provare a rispondere al quesito: per le Comunità di Pratica è possibile parlare di ‘Soggettività di pratica’? Per fare questo, una riflessione teorica conclusiva si propone di collegare il costrutto di Comunità di Pratica ai recenti sviluppi teorici sulla Soggettività.
According to the Community of Practice and the Situated Action Theories, the general aim of the research is the evaluation of the interactive, relational and communicative dimensions of the introduction and use of an interactive clinical-nursing record by medical professionals (doctors and nurses) Communities of Practice. In particular, the two studies investigate, from a psychosocial perspective, the emergence (first study) and the process (second study) of Communities related to the New Technologies, estimating if this kind of communities can be properly considered as Communities of Practice, referring also to the Identity/Subjectivity dimension. The results offers interesting practical implications -from the interpersonal and organizational point of view- on communication and identity aspects of the relationship among colleagues and between doctors and nurses. The last objective is then to try to answer to the question if it’s possible to assume a “subjectivity of practice”: a conclusive theoretical proposal aims to rely the Community of practice theory to the recent progress in Subjectivity concept.

Il Diabete, modello paradigmatico delle malattie croniche, sta assumendo negli ultimi anni le proporzioni di una pandemia, che non ha intenzione di arrestarsi, ma del quale, con l’aumento dei fattori di rischio, aumentano prevalenza e incidenza. Secondo stime autorevoli il numero delle persone con diabete nel 2035 aumenterà fino a raggiungere i 382 milioni di casi. Una patologia complessa che richiede lo sforzo di una vasta gamma di professionisti, per ridurre in futuro in maniera significativa i costi legati a questa patologia e nel contempo mantenere e addirittura migliorare gli standard di cura. Una soluzione è rappresentata dall'impiego delle ICT, Information and Communication Technologies. La continua innovazione tecnologica dei medical device per diabetici lascia ben sperare, dietro la spinta di capitali sempre più ingenti che iniziano a muoversi in questo mercato del futuro. Sempre più device tecnologicamente avanzati, all’avanguardia e performanti, sono a disposizione del paziente diabetico, che può migliorare tutti processi della cura, contenendo le spese. Di fondamentale importanza sono le BAN reti di sensori e wearable device, i cui dati diventano parte di un sistema di gestione delle cure più ampio. A questo proposito METABO è un progetto ICT europeo dedicato allo studio ed al supporto di gestione metabolica del diabete. Si concentra sul miglioramento della gestione della malattia, fornendo a pazienti e medici una piattaforma software tecnologicamente avanzata semplice e intuitiva, per aiutarli a gestire tutte le informazioni relative al trattamento del diabete. Innovativo il Clinical Pathway, che a partire da un modello Standard con procedimenti semplici e l’utilizzo di feedback del paziente, viene progressivamente personalizzato con le progressive modificazioni dello stato patologico, psicologico e non solo. La possibilità di e-prescribing per farmaci e device, e-learning per educare il paziente, tenerlo sotto stretto monitoraggio anche alla guida della propria auto, la rendono uno strumento utile e accattivante.

RESUMO - Assistimos hoje a um contexto marcado (i) pelo progressivo envelhecimento das sociedades ocidentais, (ii) pelo aumento da prevalência das doenças crónicas, de que as demências são um exemplo, (iii) pelo significativo aumento dos custos associados a estas patologias, (iv) por orçamentos públicos fortemente pressionadas pelo controlo da despesa, (v) por uma vida moderna que dificulta o apoio intergeracional, tornando o suporte proporcionado pelos filhos particularmente difícil, (vi) por fortes expectativas relativamente à prestação de cuidados de saúde com qualidade. Teremos assim de ser capazes de conseguir melhorar os serviços de saúde, ao mesmo tempo que recorremos a menos recursos financeiros e humanos, pelo que a inovação parece ser crítica para a sustentabilidade do sistema. Contudo a difusão das Assistive Living Technologies, apesar do seu potencial, tem sido bastante baixa, nomeadamente em Portugal. Porquê? Hamer, Plochg e Moreira (2012), no editorial do International Journal of Healthcare Management, enquadram a Inovação como “podendo ser imprevisível e mesmo dolorosa, pelo que talvez possamos não ficar surpreendidos se surgirem resistências e que, inovações bastante necessárias, capazes de melhorar os indicadores de saúde, tenham sido de adoção lenta ou que tenham mesmo sido insustentáveis”. Em Portugal não há bibliografia que procure caracterizar o modelo de difusão da inovação em eHealth ou das tecnologias de vivência assistida. A bibliografia internacional é igualmente escassa. O presente projeto de investigação, de natureza exploratória, tem como objetivo principal, identificar barreiras e oportunidades para a implementação de tecnologias eHealth, aplicadas ao campo das demências. Como objetivos secundários pretendemse identificar as oportunidades e limitações em Portugal: mapa de competências nacionais, e propor medidas que possa acelerar a inovação em ALT, no contexto nacional. O projeto seguirá o modelo de um estudo qualitativo. Para o efeito foram conduzidas entrevistas em profundidade junto de experts em ALT, procurando obter a visão daqueles que participam do lado da Oferta- a Indústria; do lado da Procura- doentes, cuidadores e profissionais de saúde; bem como dos Reguladores. O instrumento utilizado para a recolha da informação pretendida foi o questionário não estruturado. A análise e interpretação da informação recolhida foram feitas através da técnica de Análise de Conteúdo. Os resultados da Análise de Conteúdo efetuada permitiram expressar a dicotomia barreira/oportunidade, nas seguintes categorias aqui descritas como contextos (i) Contexto Tecnológico, nas subcategorias de Acesso às Infraestruturas; Custo da Tecnologia; Interoperabilidade, (ii) Contexto do Valor Percecionado, nas subcategorias de Utilidade; Eficiência; Divulgação, (iii) Contexto Político, compreendendo a Liderança; Organização; Regulação; Recursos, (iv) Contexto Sociocultural, incluindo nomeadamente Idade; Literacia; Capacidade Económica, (v) Contexto Individual, incluindo como subcategorias, Capacidade de Adaptação a Novas tecnologias; Motivação; Acesso a equipamentos (vi) Contexto Específico da Doença, nomeadamente o Impacto Cognitivo; Tipologia Heterogénea e a Importância do Cuidador. Foi proposto um modelo exploratório, designado de Modelo de Contextos e Forças, que estudos subsequentes poderão validar. Neste modelo o Contexto Tecnológico é um Força Básica ou Fundamental; o Contexto do Valor Percecionado, constitui-se numa Força Crítica para a adoção de inovação, que assenta na sua capacidade para oferecer valor aos diversos stakeholders da cadeia de cuidados. Temos também o Contexto Político, com capacidade de modelar a adoção da inovação e nomeadamente com capacidade para o acelerar, se dele emitir um sinal de urgência para a mudança. O Contexto Sociocultural e Individual expressam uma Força Intrínseca, dado que elas são características internas, próprias e imutáveis no curto-prazo, das sociedade e das pessoas. Por fim há que considerar o Contexto Específico da Doença, nesta caso o das demências. Das conclusões do estudo parece evidente que as condições tecnológicas estão medianamente satisfeitas em Portugal, com evidentes progressos nos últimos anos (exceção para a interoperabilidade aonde há necessidade de maiores progressos), não constituindo portanto barreira à introdução de ALT. Aonde há necessidade de investir é nas áreas do valor percebido. Da análise feita, esta é uma área que constitui uma barreira à introdução e adoção das ALT em Portugal. A falta de perceção do valor que estas tecnologias trazem, por parte dos profissionais de saúde, doentes, cuidadores e decisores políticos, parece ser o principal entrave à sua adoção. São recomendadas estratégias de modelos colaborativos de Investigação e Desenvolvimento e de abordagens de cocriação com a contribuição de todos os intervenientes na cadeia de cuidados. Há também um papel que cabe ao estado no âmbito das prioridades e da mobilização de recursos, sendo-lhe requerida a expressão do sentido de urgência para que esta mudança aconteça. Foram também identificadas oportunidades em diversas áreas, como na prevenção, no diagnóstico, na compliance medicamentosa, na terapêutica, na monitorização, no apoio à vida diária e na integração social. O que é necessário é que as soluções encontradas constituam respostas àquilo que são as verdadeiras necessidades dos intervenientes e não uma imposição tecnológica que só por si nada resolve. Do estudo resultou também a perceção de que há que (i) continuar a trabalhar no sentido de aproximar a comunidade científica, da clínica e do doente, (ii) fomentar a colaboração entre centros, com vista à criação de escala a nível global. Essa colaboração já parece acontecer a nível empresarial, tendo sido identificadas empresas Portuguesas com vocação global. A qualidade individual das instituições de ensino, dos centros de investigação, das empresas, permite criar as condições para que Portugal possa ser país um piloto e um case-study internacional em ALT, desde que para tal pudéssemos contar com um trabalho colaborativo entre instituições e com decisões políticas arrojadas.
ABSTRACT - We are facing today an environement characterized by (i) progressive aging of the occidental societyes (ii) increase prevalence of cronic diseases, from which dementias are an example (iii) significant growth on costs associated with those conditions (iv) public budgtes strongly limited by cost contaimnment (v) a modern way of life that does not helps intergenerational support, where suns does not have the chance to support their parents (vi) strong society expetatction about health care services´ quality. Threfore with need to find the way to increase health services quality and meanwhile redice human an finacial resources, making innovation a critical piece to health sustainability. However the dissemination of Assistive Living Technologies, despite its potential, has been fairly low, particularly in Portugal. Why? Hamer, Plochg and Moreira (2012), in the International Journal of Healthcare Management´s editorial, have mentioned " Innovation can be unpredictable and indeed harmful so perhaps it should come as no surprise that it can produce real resistance and much needed innovations which can improve healthcare outcomes have been slow to be adopted or been unsustainable.". In Portugal there is no bibliography that seeks to characterize the diffusion model of innovation in eHealth or in Assisted Living Technologies. The international bibliography is also scarce. With this exploratory research project, we are aiming as main objective, (i) to identify barriers and opportunities for implementation of eHealth technologies, applied to the field of dementia; as secondary objectives, (ii) identify opportunities and limitations in Portugal: map of national capabilities, (iii) propose measures that can accelerate innovation in ALT, in the national context. The current project, exploratory by design, will follow the model of a qualitative study. For this purpose were conducted in-depth interviews with experts in ALT, seeking the vision of those who participate on the supply side- the industry; on the demand sidepatients, caregivers and healthcare professionals- and also on regulators´ part. The instrument used for collecting the information required was a structured questionnaire. The analysis and interpretation of the information collected were made through the technique of Content Analysis. The results of the Content Analysis performed have expressed the dichotomy barrier/opportunity, in the following categories described here as contexts (i) Technological context, with the subcategories of Access to Infrastructures; Cost of Technology; Interoperability; (ii) context of the Percecionado Value in the subcategories of Usefulness; Efficiency; Awareness; (iii) Political context, namely regarding Leadership; Organization; Regulation; Resources, (iv) Socio-Cultural context, including namely Age; Literacy; Affordability (v) Individual context, including as subcategories, Adaptability to new technologies; Motivation; Access to equipment; (vi) Disease-specific Context, namely the Cognitive Impact; Heterogeneous typology and the importance of the Caregiver. An exploratory model was proposed, designated as Model of Contexts and Forces, that subsequent studies can test its validity. In this model the technological context is a Basic or Fundamental Force; the context of Perceived Value, constitutes a Critical Force for the adoption of innovation, based on their ability to offer value to the various stakeholders in the chain of care. The Political Context, has the ability to model the adoption of innovation, including the ability to accelerate it, particulary if a signal of urgency for change is sent. The Sociocultural and Individual Context, express an intrinsic strength since they are internal features, fit and immutable in the short termthe society and people. Finally we must consider a Disease-specific context, in this case, the dementias From the study it seems clear that the technological conditions, are averagely satisfied in Portugal, with obvious progress in recent years (except for interoperability where there is a need for further progress), do not constitute therefore barrier to introduction of ALT. Where there is a need to invest is in the perceived value. From the analysis, this is an area that constitutes a barrier to the introduction and adoption of ALT in Portugal. The lack of a perceived value rearding what these technologies bring, near health professionals, patients, caregivers and policymakers, appears to be the main obstacle to its adoption. Are recommended strategies for collaborative research and development models, and approaches of co-creation with contribution of all actors in the chain of care. There is also a role for the State in the context of the priorities and the mobilization of resources, and what is required it´s the expression of the sense of urgency to make this change happen Opportunities were also identified in several areas, such as in the prevention, diagnosis, drug therapy, compliance, monitoring, support to the daily life and social integration. What is needed are solutions to offer meaningfull answers to what are the real needs of players and not a technological enforcement which will not solve patient´s issues. We also found that it´s required to (i) continue to work towards bringing the scientific community, to the daily clinic and the patients (ii) foster collaboration between centres, as the only possibility for the creation of global scale. This collaboration already seems to happen at business/entrepeneurs level, with the identification of some Portuguese companies acting nowadays as global players. The individual quality of educational institutions, research centres, companies, if accompanied by a collaborative work between them and bold political decisions, would create the conditions to establish Portugal as a country pilot and a case-study in ALT.

Information and communication technologies can be used to deliver healthcare services and improve the healthcare system. Any electronic healthcare system whose usage results in the efficient and enhanced quality of healthcare is an eHealth system and can be beneficial for medical enterprises. Despite the advantages that eHealth systems offer, medical enterprises are often reluctant to abandon their paper-based systems and embrace eHealth solutions. Through a review of existing eHealth literature, this study identified generic technologies used within South African medical enterprises. Fourteen (14) technologies, that represent a basket of eHealth systems for supporting the business management, professional clinical informatics, patient information storage and consumer health informatics functional areas, were identified. The study then aimed to determine the state of adoption of these technologies as well as the factors influencing adoption. The technological, organisational and environmental (TOE) factors that contributed to the current state of adoption were identified through a review of existing TOE literature. A model that explores the effects of these pre-determined TOE factors on the propensity to adopt eHealth was developed and tested. A cross-sectional, quantitative study was carried out and survey data was collected from a sample of 130 medical enterprises in South Africa. Data was collected using a structured questionnaire. Correlation analysis was used to test the model’s hypotheses and hierarchical regression was used to test the overall TOE model. By using the TOE framework, the study has provided a theoretical contribution and addressed a gap in the literature into the barriers and determinants of the adoption of information and communication technologies (ICTs) in healthcare. The results of the study show that South African medical enterprises use systems that range from simple electronic fund transfer systems to more complex electronic record and clinical decision support systems. Of the 14 technologies that were identified, business information systems such as medical aid claims submission systems and electronic record systems for patient and fee related information were the most adopted while a steady, but continued increase in the adoption of clinical health information systems was observed. Specifically, the study reveals that electronic fund transfer systems are the most adopted systems while ePrescription systems are the least used. Furthermore, the study shows that in addition to the enterprises’ operating period, perceived benefits, IT infrastructure, senior clinician involvement, resource commitment and external pressure are correlated with the propensity to adopt while system complexity is a barrier to technology adoption.

O paradigma da prestação de cuidados de saúde está lentamente a alinhar-se com as necessidades e hábitos do paciente moderno. A computação ubíqua pode ser uma solução para responder à crescente tendência e necessidade para a partilha e colaboração de cuidados de saúde. As tecnologias móveis possibilitam o redesenhar de processos dando origem a novos modelos de prestação de cuidados de saúde. Face à demanda do paciente/consumidor e da influência que possa vir de outros países e mercados, é expectável que o mercado nacional acompanhe a tendência para a adoção de iniciativas de mobile health. Utilizando a metodologia proposta por Arksey e O’Malley, segundo as melhorias sugeridas por Levac et al., propõe-se a realização de um levantamento das iniciativas de mobile health (mHealth) em Portugal, que sirva de apoio à tomada decisão aos stakeholders. Espera-se com este levantamento obter conhecimentos sobre as iniciativas e o seu estado de implementação em Portugal. O mapeamento do estudo permitirá sumarizar o conhecimento adquirido, e apresentar os resultados num formato acessível e resumido para que decisores políticos, profissionais e consumidores possam fazer uso efetivo das conclusões.
The paradigm of health care delivery is slowly aligning with the needs and habits of the modern patient. Ubiquitous computing can be a solution to respond to the growing trend and need for health care sharing and collaboration. Mobile technologies enable the redesign of processes giving rise to new models of health care delivery. Given the patient / consumer demand and the influence that may come from other countries, it is expected that the national market will follow the trend towards adopting mobile health initiatives. Using the methodology proposed by Arksey and O'Malley, according to the improvements suggested by Levac et al., It is proposed to carry out a survey of the mobile health (mHealth) initiatives in Portugal, which will support the decision-making process for stakeholders. This survey is expected to gain insight into the initiatives and their status of implementation in Portugal. Mapping the study will summarize the knowledge gained and present the results in an accessible and summarized format for policy makers, practitioners and consumers to make effective use of the findings.

The thesis discusses how information and communication technologies (ICT or IT), nowadays transforms the form of health and social services. The specific arguments and social events are described, that leads today's health and social services closer to the use of ICT, influence and changes it. The work describes the latest trends linking ICT and social and health services in the areas of e-health, telemedicine, mobile health and assistive technologies. Specific tools and equipment and their practical use are presented. The practical part focuses on the introduction of specific- gadgets tablet care in caring for the elderly. Through direct interviews with caregivers and seniors is investigated how new technology is perceived by caregivers and seniors, how new technology equipment to care are introduced, and what positive and negative impact are the ICT has for facilities and the elderly. Key words assistive technology; eHealth; mHealth; patient engagement; population ageing; senior activation; senior care; telemedicine; touch tablets

Le système de santé d'aujourd'hui fait appel à de nombreuses technologies de l'information nommées TIS (Technologies de l’Information en Santé). Celles-ci ont donné naissance à de nouvelles formes d’interaction médecin-patient et ont complexifié l'approche thérapeutique dite
« centrée sur le patient ». Les TIS promettent une plus grande efficacité et l’augmentation de la satisfaction des patients par le biais d’une meilleure compréhension de la maladie pour le patient. Or, elles peuvent également devenir des sources de conflit pour le professionnel de la santé, étant donné leur utilisation en dehors des rencontres cliniques ainsi que leur tendance à agir comme des barrières communicationnelles lors des consultations. Cette recherche vise a étudier les critères de design nécessaires à la conception d’un TIS pouvant améliorer la relation médecin-patient et donc, faciliter la communication et améliorer l’alliance thérapeutique. L’étude utilise une approche centrée sur l’utilisateur et vise donc à comprendre les besoins et les attentes des médecins et des patients. En étudiant les nouvelles approches en santé et les TIS, il a été possible de comprendre le contexte et les besoins des utilisateurs en terme de communication. Ces derniers sont primordiaux au processus dit centré sur l’utilisateur. Le faible taux de rétention du discours du médecin devient une barrière communicationnelle importante, tout comme le temps pressurisé. La recherche nous montre que l’ajout d’un outil virtuel de vulgarisation peut, à l’aide de média visuels (tel que des modélisations, des animations 3D et des dessins), grandement aider la relation médecin-patient.
Today’s medical system is using an increasing number of information technologies to help healthcare professionals in their daily practice. Commonly known as HIT (Health Information Technologies), they create new forms of doctor-patient interaction and complexify the therapeutic approach called “patient centered approach”. Their use promises to improve the efficiency of the healthcare system and the overall satisfaction of the patient by improving his understanding of his illness, yet they can also become communication barriers during a consultation and even a source of conflict when used outside a clinical context. This research project aims at studying the design criteria for a Health Information tool that can help improve the doctor-patient relationship. The study uses a user-centered approach and therefore, focuses on understanding the needs and expectations of both doctors and patients. The study of the theoretical and "on the field" therapeutic approach shows that the pressurized time of the consultation, the many communication barriers and the low level of information remembered by patients are problems that can be solved by a HIT. A virtual vulgarization tool that uses multimedia such as 3D animations, 3D models and drawings can considerably help the doctor-patient relationship.