TV-based systems were also proposed in different contexts. For example, in a combined TV-computer solution was proposed to explore the idea of a "hidden" computer behind the TV console providing the main functionalities of a computer. The system was tested by a group of 14 seniors. In, an interactive platform, running on an Android STB, was developed and tested by 8 participants over 60 years old to promote the info-inclusion in the elderly population, providing informative contents about useful services, previously obtained via focus groups. Its current application is somehow limited since it is based only on open streaming TV channels. Commercial solutions are already available to offer social interaction, like photo sharing and videoconferencing, social activities, teleconsultation and health reminders.
The promising results already obtained with TV-based systems with the senior population emphasize the viability of this type of solutions, which are still relatively rare. In particular, for TV-based remote biometric monitoring, there are no commercially available solutions.
In this context, we previously proposed VITASENIOR-MT telehealth solution, a platform that does remote monitoring of biometric and environmental parameters. The solution was specifically designed for a senior population with low digital literacy and considering the physical and cognitive limitations that they may present. Thus, both system's easiness of use and learning curve were key aspects considered during the development. At the same time, the solution was designed to be highly scalable in a perspective of gradually adding new heterogeneous medical and environmental devices, but also from a perspective of the number of home users (customers), always ensuring safety, security and privacy of data.
In and, we focused on the implementation details and the validation of system stability from a hardware and software perspective. In the current paper, the main goal is to evaluate the usability of the TV-based VITASENIOR-MT solution as a telehealth platform. We report the experimental evaluation of the solution by end-users, considering its usefulness, satisfaction, ease of use and ease of learning. The solution was designed and validated following a user-centred design (UCD) perspective along 3 phases. The first phase was used to collect users' feedback about the system and to adjust it accordingly (this period was longitudinal to the project development). In the second phase, the system was systematically assessed by a group of 20 seniors from elderly care centres and a control group of 20 people outside those centres, who answered to questionnaires assessing usefulness, satisfaction, ease of use and ease of learning. Then, three participants, selected from the senior group, used the home-care platform for two months. The home-care platforms were installed in 2 different senior centres (nursing homes), where experimental tests were conducted with the elderly and health professionals (doctors and nurses of the institutions). The main contribution of the paper is to set forth the viability of the interactive telehealth solution via TV for the elderly population. The solution showed a high usability regardless of age, digital literacy, education and impairments (sensory, motor and cognitive), which shows its effective potential for use and implementation in the senior market.
VITASENIOR-MT was designed as a highly scalable telehealth IoT platform that remotely monitors biometric and environmental data. The system comprises four subsystems: a home-care platform based on a TV set for interaction with direct end-users, a wireless sensor network (WSN) for environmental data collection, a cloud infrastructure following a microservice and fog-computing architecture and a web portal for interaction with formal and informal caregivers. The overall architecture is shown in Fig. 1, and the functional parts concerning user-interaction will be described in the following sub-sections highlighting the functionality, reliability and usability of the provided services (technical implementation details regarding the Cloud infrastructure, security and privacy mechanisms are not included in this paper, as they were already reported in).
The core of the telehealth home-care platform is based on a Raspberry Pi 3 (RPi3) micro-computer integrated into a hub-box called VITABOX, which is responsible for interacting with a TV, Bluetooth medical devices, IEEE 802.15.4 WSN, and the cloud infrastructure. The RPi3 has all the required communication modules, namely Bluetooth, WLAN IEEE 802.11, HDMI-CEC (consumer electronic control) and USB to connect to the IEEE 802.15.4 WSN border router (inside VITABOX). Both VITABOX and the set-top box receiver are connected to the TV set through 2 HDMI ports, making the telehealth approach independent of the television service provider. Toggling between these two modes occurs either manually, at the user's own initiative, using the TV's remote control, or automatically, when alarm situations are triggered by abnormal values of environmental sensors. The interaction of the direct end-user with the telehealth system is done through the TV's remote control. This feature was a key design and implementation requirement of the VITASENIOR-MT system, which aims to be familiar, functional, easy to use and requiring the minimum number of steps as possible to perform the telehealth tasks. The end-user accesses all features of the home-care platform through 7 keys of the remote, namely, "OK", "L/R/U/D Arrows", "Back" and "1", as depicted in Fig. 2. The "1" key is used to toggle between TV and telehealth modes, by user's own initiative. If the user receives a notification at the lower right corner of the TV while watching TV (see Fig. 1), the TV also toggles to telehealth mode by pressing the key "OK" and shows the notification screen. In telehealth mode, the user has an initial welcome screen with information regarding the day, date and time, weather information and a list of the open pharmacies nearby. From the sidebar menu, the user can access the main options such as "Exams", "Exam history" and "Environmental history" using the remote's arrow keys (see demo videos1). After choosing the desired option, the user selects at the top of the screen the tab associated with his/her profile, since more than one user can be registered in the same platform (e.g. a couple). By selecting the "Exams" sidebar option, a set of medical devices associated with the user's profile is exhibited. Currently, the following medical devices are available: blood pressure meter, glucometer, oximeter and weight scale (heart rate is included in the blood-pressure meter and the oximeter). Each medical device is selected by pressing the remote's "OK" key. The "instructions of use" are image- and text-based, accompanied by audio-description. Each medical device has its own way of operation, like any other regular device. For example, a blood pressure measurement requires pressing the start button, whereas for the weight scale the user only needs to step on the scale. The communication between VITABOX and the device occurs in a transparent way, without any intervention from the user. At the end of the measurement, the data are transferred to the VITABOX and communicated to the user in a visual and auditory way. Visual layout, audio texts and interaction procedures were all adjusted based on the feedback of end-users and professional and informal caregivers, during the first phase of the usability tests in a UCD perspective, as described in sect. 3. Environmental data (CO, CO2, temperature and humidity) are collected from the WSN transparently and made available for visualization on the TV. Implementation details can be found in.
VITASENIOR-MT web portal was implemented as a progressive web application (PWA), allowing it to be installed similarly to a native application in any device that runs a web browser, making access to the platform easier. It was designed considering usability requirements that could serve users with different experience levels, who in most cases are not familiar with new technologies. All VITASENIOR-MT users with an account can interact with the web portal, namely doctors, formal caregivers (nurses, geriatric nursing assistants) and informal caregivers (family members) and direct end-users. On the other hand, the system was built ensuring the installation of the home platform's kit was as plug and play as possible (that includes the VITABOX, medical devices, and environmental sensors). This is done by pre-registering all equipment, still inactive, which will be available for installation.
The user responsible for the VITABOX (e.g. a relative of the end-user, hereinafter referred to as sponsor) is able to acquire and associate additional equipment to his/her VITABOX (e.g. an extra environmental sensor), as well as to define the VITABOX location used for geo-tracking in case of alarm events or to locate nearby pharmacies. The sponsor is responsible for registering patients associated with the VITABOX, define other users as caregivers, associate doctors to patients and define which devices (medical and environmental) will be used by each patient, allowing the system to scale not only in the home environment, but also in nursing homes or hospitals.
The provided web portal allows a user with a caregiver account to view historical data of his/her associated patients, which includes environmental and biometric information. Moreover, VITABOX and patients' data such as location and prescribed medication among others are also accessible, being helpful in settings where a caregiver follows/assists multiple seniors in assisted homes or their homes. The doctor may consult the biometric history of the patient and be automatically notified when the values fall out of the acceptable ranges. These notifications are triggered based on the clinical profile previously defined by the doctor (settings include minimum and maximum thresholds in different periods of the day). The doctor also has the possibility of scheduling the examinations to be performed periodically (including several schedules in the same day). A reminder is issued, appearing on the TV whenever the senior delays or fails to perform a given examination or measurement. The history of biometric data can be printed to pdf, producing a report that patients can take when attending a medical consultation with doctors who do not have access to the platform. Data can be as well exported to csv files for data analysis.