vCare Tech-Labs successfully completed!

The vCare Tech-Labs have been successfully completed!

vCare is focusing on four pathologies: Stroke, Parkinson’s disease, heart failure-and Ischemic heart disease. For each pathology, a clinical pathway and related activities and the modalities of interaction with the virtual coach have been defined by the clinical partners of the project.

The objective of the Tech labs was to verify that the technical components developed or made available by the technical partners were actually meeting the requirements previously validated. To achieve this result, the technical partners have developed a battery of tests. For each test, we have defined the preconditions to be met, the test execution modalities and the validation dimensions to be assessed. Those tests have been performed within the premises of the technical partners in Austria (AIT), Spain (MySphera) and Germany (FZI) but also involved SIVECO (Romania) and TUD (Germany). Due to the COVID-19 situation, partners have however been unable to travel to the different sites and the tests have been performed with the support of videoconferencing.

Each Tech lab tested an individualized setup in order to focus on specialized parts of the vCare system. While Germany’s tech-lab performed extensive experiments for AI-based clinical pathway adaptation, the technical sight in Austria dealt with intelligent end-user interaction and Spain’s premise tested the overall system integration. As a consequence, each Tech lab followed the concept of semi-integrated testing, where required vCare sub-systems were evaluated in terms of data flow and business logic. A semi-integrated test refers to an experiment for a particular sub-system, where data is partially simulated or collected offline to the extent that the sub-system can be confidently validated.

 

The Tech-Lab Germany as an example

For testing the vCare knowledge layer and its capabilities to recommend personalized activities for individual patients, the tech-lab Germany conducted experiments to (i) automatically gather all relevant information for decision-making (e.g. the patient’s current care plan, the development of her/his vital parameters over time or her/his clinical history), (ii) exploit a curated corpus of expert rules to adapt the care plan according to clinical guidelines and medical expertise and (iii) perform AI-based care plan adaptation based on advances reinforcement learning algorithms.

vCare relies on a study design which involves clinicians and end-users at each stage of its development. During this phase, the medical partners have been invited to submit their comments and impressions during and after the tests. The resulting discussions disclosed the need to make central data processing- and decision-making tasks sufficiently transparent and did yield a shared understanding of the vCare system. An exemplary result are advanced dashboards, which visualize the used input data for pathway adaptation, which are continuously improved during the living-lab phase.

Here, the focus was also on information processing. While the test implementation concentrated on the exchange of simulated data via the defined interfaces, the regular discussions with the medical partners allowed additional knowledge about the processing of more extensive data from a medical perspective and the modalities of interaction with patients to be integrated. As central result, vCare has compiled a comprehensive test summary report for both functional and non-functional requirements. All individual integrated as well as semi-integrated test cases were conclusive, showing that required technical interfaces between layers and components are available and functional.

Here is a detailed example of how a specific requirement has been tested in one of the Tech-Lab:

Services: CS5 Rehabilitation coach Requirement: R4-6 Personalized and context-aware interaction and feedback
Context:

The VC, considering the daily state of physical inactivity of the user protracted for a long time (personal state), considering the good weather (environment profile), considering the user’s compliance (personal state & historical information), considering the user’s health status (clinical state), and considering the reconstruction of his afternoon habits (clinical pathway profile), proposes a physical activity among those available in the clinical pathway (activity profile & clinical pathway profile): a walk outside in the open air at a pace of 5km/h for 30 minutes.

 

Test:

–        The technician verifies that the system stores the information of “High level of user inactivity”, “favourable weather forecast”, “usual walk outside” and “adequate clinical state”.

–        The technician checks the logfiles to verify that IF high level of user inactivity AND favourable weather forecast AND usual walk outside AND adequate clinical state, THEN the VC proposes the coaching for an active lifestyle activity: “walking outdoor at 6km/h for 30 minutes”

 

Test setup – precondition:

  • Technical partners generate exemplary clinical state attributes of a patient
  • Integration tests on processing the state attributes of a patient
  • Simulated knowledge input about the weather and habits inserted to the knowledge layers RDF-store
  • Integrated tests on proposing activity

This describe the message flows between the knowledge layer, reasoner and MQTT middleware.

A number of adjustments and more detailed specifications were during the TechLab in  dicsusion with the medical partners:

For example, we had to precise what “favourable weather forecast” could concretely mean. And the answer has been:

  • NO RAIN
  • NO ICE
  • NO FOGG (to avoid visibility problems)
  • NO dark hours (1 hour after sunrise and 1 hour before sunset) (to avoid visibility problems)
  • temperature < 30°C

The “adequate clinical state” is defined by the objective- and subjective assessments of a patient’s physical health and fitness.  In this case, walking can be proposed:

IF hip, knee and ankle conditions are either medium or high (freedom of  movement)

 AND Balance skills level is acceptable

AND the level of perceived exertion is either medium or low.

 

Test execution:

  • Integration test: messages holding information about different clinical state parameters are processes via the MQTT broker properly and are stored in the knowledge layer
  • Trigger: receiving messages about a patient inactivity via MQTT broker. Message to the topic of “vcare/<patientid>/observation”
  • Reasoner: automatically checks if all conditions are met.
  • Proposes walking for 30 min at a pace of 6 km/h as a new scheduled activity to the broker

 

Test validation:

  • The reasoner compares the current state of the patient received by the MQTT broker to the threshold values defined by our medical partners
  • The reasoner generates a new scheduled activity as defined in the vCare ontology and provides this information to the topic of the patient’s individual care plan

 

Comment medical partners:

Input summary Output summary Comment (Medical Partners)
to test this use case, we simulate a patient and store information about a simulated agenda in our knowledge graph. We also insert information about the patients habit of walking outside, that would be extracted as a pattern in the long run. VC proposes the coaching for an active

lifestyle activity: “walking outdoor at 6km/h for 30 minutes”

For a first test this condition is correct. Complex conditions defined in TechLab to be continued.

 

Test summary:

To complete this test, it proved necessary to define the extensive specification of the mentioned input conditions.  Through interactions with the medical experts, it was possible to define not only the requirements for this exact use case, but also the basic rules that are used for suggesting activities in our Smart Agent.

In addition to these content-related achievements, we were also able to test and validate the integration of the relevant components.  Both the recording of clinical conditions of the patient and the provision of information about a new planned activity could be achieved in cooperation with the respective technical partners.

 

vCare is now ready for the Living-Labs !

The report also describes the progress in the technical integration of the technical vCare components and how the medical knowledge has been concretely integrated into the technical components of vCare. All technical interfaces are now fully defined and implemented: Data and information flow is now possible throughout the vCare system.

Now that those tests have been successfully fulfilled, vCare can begin the Living labs phase: The vCare system will be tested in a controlled environment by real patients and feedback will be collected in a structured and continuous way. This will result in the identification of gaps and/or to the adaptation of requirements which will then will need to be again tested. In order to ensure efficient and fruitful Living lab experiments, both medical- and technical vCare experts will be available to observe and interact with the participating patients.

Workshop Multimodal e-Coaches @ ICMI 2020

The vCare project consortium is, together with other PM-15 projects, among the co-organisers of a Workshop on “Multimodal e-Coaches” at the 2020 edition of “ACM International Conference on Multimodal Interaction” (ICMI 2020). ICMI 2020 was initially scheduled  for 25-29 October 2020 in Utrecht, The Netherlands. Due to the pandemic situation, ICMI 2020 has switched from a physical organization to a virtual one. The workshop day: October 25 or 29, 2020 (still to be decided).

e-Coaches are promising intelligent systems that aims at supporting human everyday life, dispatching advices through different interfaces, such as apps, conversational interfaces and augmented reality interfaces. This workshop aims at exploring how e-coaches might benefit from spatially and time-multiplexed interfaces and from different communication modalities (e.g., text, visual, audio, etc.) according to the context of the interaction.

We would much appreciate any contribution. For details, see the workshop website: https://multimodal-ecoches.nestore-coach.eu/

vCare @ EHMA 2020

The vCare project will be present at the 2020 edition of the well-known conference of the European Health Management Association (EHMA).

The COVID-19 pandemic continues to show the importance of bringing experts together, exchanging practices and finding shared answers to tackle key public health issues. However, having carefully revised the latest information offered by local, national and international authorities, and having run consultations among the Members of the EHMA Board, the Conference Hosts, the members and main stakeholders, the conference chairs concluded that the only way forward to ensure the safety of everyone is for the EHMA 2020 Conference to take place as a digital event. EHMA is  aiming at unforgettable virtual experience, using the latest developments in software and most effective engagement tools to make sure that we organize an absolutely unique EHMA 2020.

It is in this context that our abstract on the vCare approach will be presented on DAY 1 – TUESDAY, 17th NOVEMBER 2020 – from 17.00 to 18.30 CET. The session title is “Parallel Thinking: Digital Transformation”.

For more information, see the conference website: https://ehmaconference.org/events/ehma2020/

Digital Therapeutics and Care at Home

On the 3rd June 2020, EHTEL launched the webinar Digital Therapeutics and Care at Home. It was part of the Imagining 2029 work programme, a programme building on a series of webinars and workshops – hosted by its working groups – focused on accelerating digital transformation while acknowledging the opportunities and challenges raised by the current COVID-19 crisis. This webinar belongs to the Innovation Initiative agenda for 2020: Exploring Digital Therapeutics, Artificial Intelligence, and Virtual Coaches.

Research physiotherapist, Riccardo Re, showcased a neuro-rehabilitation example of digital therapeutics from the vCare’s project partner Casa di Cura del Policlinico in Milan, Italy. Focusing on work in the vCare project, Massimo Caprino, then talked about the vCare customised clinical pathway when carrying out home rehabilitation. Key points included: adherence to the care plan and patient empowerment.

A summary of the presentation is available on EHTEL’s website; CCP’s full presentation is available here.

Gap spotted: Opportunities for virtual coaches

vCare spots a gap: New opportunities for virtual coaches on patient rehabilitation

Led by Peppino Tropea of Milan’s Casa Cura Policlinico, members of the vCare team have mapped recent literature on the use of virtual coaching use in medical care. Their scoping review was on innovative practices.

Given the rapid increase in focus on artificial intelligence and data analytics, virtual coaches are now coming to the fore.

The available literature shows how virtual coaches are being used to engage and guide patients in their ongoing plan of care.

The materials available in three publishing databases, Embase, PubMed, and Scopus, were assessed: at the starting-point, they were almost 400 in number. The result was an overview of close to 50 publications. The focus was on studies with a medical or a clinical orientation.

Chief among the uses of virtual coaches were: managing weight and nutrition, and managing or self-managing chronic conditions like heart failure, chronic obstructive pulmonary disease, depression, and chronic pain. Encouraging physical activity is a main theme among today’s virtual coaches.

The range of virtual coaches covered “embodied conversational agents”/avatars, electronic coaching programs, smart devices, and support through apps.

With patients, virtual coaches can be used for many more purposes in the medical and clinical fields than they are today.

vCare hopes its insights into the opportunities that this gap offers “may inspire new ideas for future work [..] on virtual coaching.” Rehabilitation, in particular, the authors say, is “the great absentee”, the obvious missing link.

In total, a dozen authors from five institutions in Denmark, Italy, Germany, Romania, and Spain worked to produce this report. They come from a wide range of disciplines in medically-oriented universities, hospital neurological departments, and business schools and economics faculties. Collectively, it is their hope that their work enhances “constructive dialogue between bioengineers and clinicians in creating innovative technological platforms [that can deal with] with new challenges in the world of medical care.”

 

Publication date: 1 October 2019

Location: JMIR – https://www.jmir.org/2019/10/e12805

vCare at EuroPrevent 2019

Stefan Busnatu from vCare’s consortium member UMFCD will present the project’s idea for a virtual coaching system at the EuroPrevent 2019. EuroPrevent is the leading international congress on preventive cardiology and the annual congress of the European Association of Preventive Cardiology (EAPC) of the European Society of Cardiology (ESC).

vCare at Innovation Sprint regulation workshop

vCare contributes to Innovation Sprint regulation workshop

On 7th November 2018 at the Brussels Life Science Incubator in Brussels, three vCare partners took part in a workshop organised by Innovation Sprint. It was about: “Innovation uptake in eHealth with patient-centeredness and gamification. Regulatory challenges and opportunities”.

The scope of the workshop was to brainstorm the status of regulatory and ethical scenarios in eHealth, and how to get to market. State-of-the-art European Horizon 2020 eHealth projects (vCare, COUCHGOAL) got feedback on their work from a mixed disciplined audience.

Workshop participants

Sofoklis Kyriazakos – Chief Executive Officer (CEO) of Innovation Sprint, coordinated the project presentations that showcased best practices and lessons learned in European projects.  Alfredo Cesario, Chief Scientific Officer of the company, moderated a “crash test” session with the three projects – its goal was to help the projects make good decisions and avoid bad ones.

Sofoklis Kyriazakos speaks at the workshop

vCare, like the other two projects, was offered feedback on its status and the barriers it will face when dealing with regulations at its exploitation stage. vCare technical coordinator, Dr. Hannes Schlieter said, “It is really great for us to consider, even a year into the project exactly what legal and regulatory challenges we will face going ahead.”

Lucia Pannese – CEO of Imaginary, presented “Savings and better QoL: Gamifying Rehab“ from her experiences in research and development (R&D), and commercialisation. Marc Lange, Secretary General of EHTEL, spoke about the expected transition of vCare from R&D into practice: “Virtual Rehabilitation Coach: a journey from the proof of concept to routine care“.

Marc Lange speaks at the workshop

The workshop outcomes will be summarised in a White Paper with contribution from all the three partners. The ultimate aim is to create impact on the part of research-based projects at this critical point of regulation in R&D.