Albanian Mobile Assistant for Chronic Diseases Rezarta Kapaj Arbër Thaçi Alda Kika Department of Informatics, Software Developer Department of Informatics, Faculty of Natural Sciences, APPFORGOOD SRL Faculty of Natural Sciences, University of Tirana, arberlthaci@gmail.com University of Tirana, rezarta.kapaj@fshn.edu.al alda.kika@fshn.edu.al smartphones to monitor chronical diseases and reduce this way the number of hospitalized patients. Our goal is to give Albanian smartphone users a solution to Abstract improve their quality of life by managing their medical records and medicine timetables. The main problem The purpose of this paper is to present alMED, concerning patient drugs treatment is that most of them a mobile application designed to improve the forget to take their medicines in the right time or self –management of chronic diseases by the dosage, or even confuse treatment of one disease with patients themselves. Since the number of another. This causes medication adherence chronic disease patient is increasing every day [AAJKL15], which refers to the degree or extent to worldwide, monitoring and management of which a patient takes the right medication at the right chronic diseases is becoming a major concern time according to a doctor’s prescription. even for the Albanian Healthcare System. The Many studies have reported that non-adherence may current state of alMED provides intelligent, critically affect the patient, thereby raising medical user-friendly and secure application to keep costs [PL12]. Our system gives a solution for this track of the user medical records. It also works problem from the combination of sophisticated data as a reminder for patients’ medicine dosage analytics and mobile technologies. [SN12]. Using the and timings for multiple diseases. Patients are mobile health application the patients will be able to notified by the application each time they need manage their health and the professionals will be able to take a medicine, preventing them from to deliver the best care possible away from doctors and forgetting to take them. In the future our goal hospitals, closer to where patients live work and travel is to make this application part of a larger [ECL15]. alMED notifies the patients for the time and system which includes the interaction between dosage of the medication they have to take for every the patients, health care providers and disease. Except this it also provides a ‘Diary’ interface pharmaceutical providers. to keep track of daily measurable health components. 1 Introduction 2 Related Work The healthcare system all around the world is facing There are many mobile health applications in use rising costs with the rising of the number of chronic around the world, especially in the developed countries diseases in the population [APG13]. It is a fact that which provide different types of health assistance to nowadays people neglect their healthcare because of their users, being those patients or healthcare providers. their busy life, responsibilities, every day stress etc. In this paragraph we will discuss some of the most used Usage of smartphones has increased rapidly reaching mobile systems of this type. Some of these new mobile an approximate number of 2082.7 million users. applications are specifically targeted to assisting Mobile technology has become an important part of individuals in their own health and wellness everyday life even in the developing counties, and management. Other mobile applications are targeted to people are gradually becoming aware of the benefits healthcare providers as tools to improve and facilitate gained using mobile biosensor-based application in the delivery of patient care [FDA15]. According to improving their health care [SS12]. Mobile health Research2Guidance there are more then 100 000 promises to improve patient care through early disease mobile health application offered by IOS and Android. diagnosis and early disease testing. The cost of It also values that at least 50% of 3.4 milliard mobile healthcare system will be reduced by using users all over the world will download mobile health applications of some kind by 2018. Further are listed This application is named alMED, where ‘al’ stands for some of the best mobile application in Android and Albania and ‘MED’ stands for medication and IOS platforms [S15]. medicals. 1. MyChart allow you to access your medical records on your phone at any time. You can quickly see which vaccinations you’ve had and when at a glance, along with the last time you visited the doctor and which prescriptions you’re taking. You can even send a non-urgent message to your clinic and receive a response within a couple days, schedule visits from directly within the app, and request prescription refills. Best of all, you can Figure 1: Application Logo see all your information online if you can’t access it due to cellular outages. Overall, this is a medical mobile application that assists 2. CareZone Managing medication can be a chore the users in planning their medical timetables. The (and confusing). Thankfully, CareZone lets you application is developed in Eclipse using Java for curate a list of medications, dosages, and schedules Android as programming language, internal (SQLite) directly from your photo library. The application [SQLITE16] and external libraries (Google Play also allows you to document and share symptoms Services, MPAndroidCharts and A.C.R.A.).When the with your family or doctor, while giving you the application launches, the first interface is the ‘Diary’ means to store vital insurance information and interface which contains a list of daily measurable schedule reminders for upcoming appointments. components. The personalized health tips and ability to assign to-do lists and store important documents for future reference are only a plus. 3. WebMD When people think of WebMD, it’s probably just to make fun of how it’s often the first place people go when they need to figure out what illness or condition they have. The iOS application offers the same thing, but alongside that, it also allows people to set medication schedules, create a process with which they can use to meet a personal health goal, and check for local physicians and pharmacies you may not be aware of. And if you find yourself in need of a first aid advice or instructions, the application has that too, and it doesn’t require an internet connection. After reviewing the features that each one of the above applications offers we will study the possibilities of Figure 2: ‘Diary’ Interface integrating and adopting the best of them in our system considering all the challenges and conditions of the After daily check-up (this check-up is done by the user Albanian healthcare system and users. itself or according to his doctor’s analysis) the user can fill each of these components with the right data. Also, 3 Proposed System and the user can access his data for the previous or future Implementation days from the calendar or from navigation buttons in the action bar. The ‘Calendar’ interface of the application gives the user a brief historical look to his own daily data, which are saved in the local database. Clicking in a specific date of the calendar sends the user to ‘Daily’ interface on that date to display those data in detail. Another interface (which is also the core of this application) is the ‘Therapy’ interface, which consists in a list of all the therapies created by the user. Figure 4: System Use Case Google Fit does not offer just the service of the steps management, but also the other services from the fitness repository [FIT16]. These services are: ● Heartbeats ● Sleep Figure 3: ‘Therapy’ Interface Number of steps is calculated by Google based on users’ physical activities, like walking or running. GPS technology included in all Smartphone models available in the market nowadays, offers the possibility In the main menu there is also the profile icon, which to obtain a good precision in performance analysis by clicking on it sends the user to the ‘Profile’ through position and velocity of a motion body using interface. In this interface the user can see his own private data like his first name, last name and his photo. Satellite triangulation methods. In the profile it is also displays the types of diseases alMED takes advantage of this technology in order to from which the user suffers. The diseases are to be monitor data related to workout session of the patient: chosen from a default list. The reason of choosing the - Distance/route taken in the workout session disease from a default list is that its name will be used by BLE (Bluetooth Low Energy) to find other users - Instant and average speed of the session nearby which suffer from the same disease. alMED can make use of an array of sensors already Another feature of this application is the contained in modern, such as cameras, microphones, implementation of Google Fit. GPS receivers, accelerometers, etc. In our application, beside the number of steps which are shown in real time, the user can also access his historical data. The historical data are displayed on two forms: ● Numerical, which can be accessed from the diary for the current date or the previous dates ● Graphical, which are overall data shown in Some of the main components of this large architecture graphical view are:  Patient: is a person with some kind of health problem.  Clinician: is a healthcare professional who is treating or helping the Patient with the health problem, i.e. a nurse, a General Practitioner, or a specialized physician.  HealthCare Provider (HCP): is the entity that is utilizing a mobile health Service in the monitoring, diagnosis and treatment of the Patient. Figure 5: Graphical presentation of the number of  Mobile Health Service (mHS): is the service that steps performed during 5 days connects the Patient to the Clinician, and ensures data measures, transport and protection. To display the graphical view for the number of steps, we have implemented an external library named  Mobile Health Service provider (mHSP): is the MPAndroidChart [GITHUB16]. Using its methods and entity providing the mHS through a mobile health features we can provide to the user a very user friendly Platform (mHP). graphical view. In our application we have chosen the  Mobile Health Platform (mHP): is the IT system column chart. The graphical view displays the user’s connected to the mobile network to provide all data since the installation until actual day. To make it necessary functionality. more interesting, the chart is also animated.  Mobile Health Device (mHD): is a device needed The application is in Albanian because it is intended for to use the mHS and to connect to the mHP. the Albanian market, and makes it user-friendly.  Pharmacy: is the drugstore where the patient can get the prescribed medicine. 4 Future Challenges for an Integrated Another key-feature of this architecture, which also Albanian Healthcare System represents an innovation in Albania, is the inclusion of the pharmaceutical providers in this architecture. Here is a simple use case for this actor as part of the system: 1. A Patient gets a medical prescription from the A future challenge in the application development Clinician process is the inclusion in a cloud-based architecture. Mobile health application combined with cloud based 2. The mobile Health Service system platform (which technologies are becoming very handy to physicians consists in centralized databases) who will be able not only to access patients data, but 2.1 Returns a list of pharmacies matching the also to combine them with geolocation information request. about bacteria, pattern of resistance, available drugs, 2.2 Makes this medical prescription available for etc., all of which is stored in cloud. the pharmacies to review in case of the As mentioned in the beginning of this paper, our future patient request. goal is to make this application part of a larger system 3. A map is available for the patient to view the which includes several actors like patient, healthcare nearest pharmacies. providers and pharmaceutical providers. In this section we will present some future ideas of the system 4. The patient can make electronic, online or cash architecture and the roles of each actor in it. payment. 5. The patient goes to the nearest pharmacy to get the promoting healthy behavior. Such reasons include the prescription medicine. cost of communication and transportation, lack of **In some cases pharmacies may provide Home scheduling, recording, and appropriate reminders, and Delivery. poor technology and infrastructure. Rural areas also usually have fewer health workers and less infrastructure per person or square kilometer, reducing the health system‘s ability to provide high- quality medical products and services. Mobile technology can aid in providing access to information, helping to lower costs [KKV14], facilitating remote care and increasing efficiencies by Figure 6: Future System Proposed Architecture connecting patients to their providers virtually anywhere. Using a smartphone application is a novel approach to improving adherence and patient behavior Security requirements are also an important aspect [LSPPB13]; it is constantly accessible, involves and of mobile health system: educates the patient, and provides a repository for patient- and medication-specific information. Health 1. Device and data security (a) In memory (b) providers of the patients who take complex medication Processing (c) Transmission regimens may value having the ability to input patients’ 2. Confidentiality and integrity of information prescribed regimens and then “pushing” them directly 3. User authentication to patients’ smartphones. Interoperability with existing 4. System availability and access to resources prescription and medical records systems represents a 5. Non repudiation (useful in case of medical vital frontier for future application development. This prescription) interoperability would shift the current orientation of For widespread success, the development of m-health adherence applications to a more provider-focused must move away from small applications toward large- technology and thereby provide pharmacists a scale platform solutions [ATKEARNY13]. potentially valuable tool to improve medication adherence. 5 Conclusions References As in the developed countries, also in Albania the use [SS12] Simon, S.K.; Seldon, H.L., Stud. Health of health related mobile applications is expected to Technol. Inform. , Personal health records: Mobile increase in various healthcare settings. These biosensors and smartphones for developing countries. applications are thought to be a valuable tool for (2012), 182, 125–132. patients, healthcare providers and other actors involved in this schema, but not all use cases can be easily [PL12] Park, KeeHyun & Lim, SeungHyeon, (2012) integrated. 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