On the Combination of Patient-Generated Data with Data from a Secure Clinical Network Environment – A Practical Example

With increasingly more mobile health applications
appearing due to the popularity of smartphones, the possibility arises
that these data can be used to improve the medical diagnostic process,
as well as the overall quality of healthcare, while at the same time
lowering costs. However, as of yet there have been no reports of a
successful combination of patient-generated data from smartphones
with data from clinical routine. In this paper we describe how these
two types of data can be combined in a secure way without
modification to hospital information systems, and how they can
together be used in a medical expert system for automatic nutritional
classification and triage.

• Jeroen S. de Bruin
• Karin Schindler
• Christian Schuh

• Data integration
• disease-related malnutrition
• expert systems
• mobile health.

[1] Points Group. (2014) “Mobile Health (mHealth) Trends in 2014”
(Accessed March 2, 2015)
[2] L. E. Burke, et al., "Using mHealth technology to enhance selfmonitoring
for weight loss: a randomized trial", Am J Prev Med,
vol43(1), pp. 20-6, 2012.
[3] N. F. BinDhim, K. McGeechan, and L. Trevena, "Who Uses Smoking
Cessation Apps? A Feasibility Study Across Three Countries via
Smartphones", JMIR Mhealth Uhealth, vol2(1), pp. e4, 2014.
[4] J. B. Bricker, et al., "Randomized, controlled pilot trial of a smartphone
app for smoking cessation using acceptance and commitment therapy",
Drug Alcohol Depend, vol143, pp. 87-94, 2014.
[5] G. Charpentier, et al., "The Diabeo software enabling individualized
insulin dose adjustments combined with telemedicine support improves
HbA1c in poorly controlled type 1 diabetic patients: a 6-month,
randomized, open-label, parallel-group, multicenter trial (TeleDiab 1
Study)", Diabetes care, vol34(3), pp. 533-9, 2011.
[6] J. E. Aikens, K. Zivin, R. Trivedi, and J. D. Piette, "Diabetes selfmanagement
support using mHealth and enhanced informal caregiving",
J Diabetes Complications, vol28(2), pp. 171-6, 2014.
[7] J. Bauer, S. Capra, and M. Ferguson, "Use of the scored Patient-
Generated Subjective Global Assessment (PG-SGA) as a nutrition
assessment tool in patients with cancer", European journal of clinical
nutrition, vol56(8), pp. 779-85, 2002.
[8] K. Fearon, et al., "Definition and classification of cancer cachexia: an
international consensus", Lancet Oncol, vol12(5), pp. 489-95, 2011.
[9] M. Muscaritoli, et al., "Consensus definition of sarcopenia, cachexia and
pre-cachexia: joint document elaborated by Special Interest Groups
(SIG) "cachexia-anorexia in chronic wasting diseases" and "nutrition in
geriatrics"", Clinical nutrition, vol29(2), pp. 154-9, 2010.
[10] A. Laviano, M. M. Meguid, A. Inui, M. Muscaritoli, and F. Rossi-
Fanelli, "Therapy insight: Cancer anorexia-cachexia syndrome--when all you can eat is yourself", Nat Clin Pract Oncol, vol2(3), pp. 158-65,
2005.
[11] J. E. Morley, D. R. Thomas, and M. M. Wilson, "Cachexia:
pathophysiology and clinical relevance", Am J Clin Nutr, vol83(4), pp.
735-43, 2006.
[12] A. J. McGeer, A. S. Detsky, and K. O'Rourke, "Parenteral nutrition in
cancer patients undergoing chemotherapy: a meta-analysis", Nutrition,
vol6(3), pp. 233-40, 1990.
[13] M. Muscaritoli, M. Bossola, Z. Aversa, R. Bellantone, and F. Rossi
Fanelli, "Prevention and treatment of cancer cachexia: new insights into
an old problem", European journal of cancer, vol42(1), pp. 31-41, 2006.
[14] L. Mariani, S. Lo Vullo, and F. Bozzetti, "Weight loss in cancer patients:
a plea for a better awareness of the issue", Supportive care in cancer :
official journal of the Multinational Association of Supportive Care in
Cancer, vol20(2), pp. 301-9, 2012.
[15] J. Arends, et al., "ESPEN Guidelines on Enteral Nutrition: Non-surgical
oncology", Clin Nutr, vol25(2), pp. 245-59, 2006.
[16] M. B. Huhmann, and R. S. Cunningham, "Importance of nutritional
screening in treatment of cancer-related weight loss", Lancet Oncol,
vol6(5), pp. 334-43, 2005.
[17] E. Van Cutsem, and J. Arends, "The causes and consequences of cancerassociated
malnutrition", European journal of oncology nursing : the
official journal of European Oncology Nursing Society, vol9 Suppl 2,
pp. S51-63, 2005.
[18] J. F. Guest, et al., "Health economic impact of managing patients
following a community-based diagnosis of malnutrition in the UK", Clin
Nutr, vol30(4), pp. 422-9, 2011.
[19] W. J. Evans, et al., "Cachexia: a new definition", Clinical nutrition,
vol27(6), pp. 793-9, 2008.
[20] T. C. Mueller, M. A. Burmeister, J. Bachmann, and M. E. Martignoni,
"Cachexia and pancreatic cancer: are there treatment options?", World
journal of gastroenterology : WJG, vol20(28), pp. 9361-73, 2014.
[21] Health Level Seven Inc. The Arden Syntax for Medical Logic Systems
Version 2.7.
[22] K.-P. Adlassnig, and A. Rappelsberger, "Medical knowledge packages
and their integration into health-care information systems and the World
Wide Web", Stud Health Technol Inform, vol136, pp. 121-6, 2008.
[23] G. Hripcsak, "Writing Arden Syntax Medical Logic Modules", Comput
Biol Med, vol24(5), pp. 331-63, 1994.
[24] European Travel Commission. (2014) “Digital Trends in
Mobile/SmartPhones” (Accessed March 2, 2015)
[25] Manhattan Research. (2009) “Physician Smartphone Adoption Rate to
Reach 81% in 2012” (Accessed March 2, 2015)
[26] A. S. Mosa, I. Yoo, and L. Sheets, "A systematic review of healthcare
applications for smartphones", BMC Med Inform Decis Mak, vol12, pp.
67, 2012.
[27] E. Murray, "Web-based interventions for behavior change and selfmanagement:
potential, pitfalls, and progress", Med 2 0, vol1(2), pp. e3,
2012.