micf - mobile icanfunction app

Improving Health and Functioning Using Mobile ICF (mICF) Technology

- the mobile ICanFunction AppPatricia WELCH SALEEBY1, Olaf KRAUS de CAMARGO2,

Stefanus SNYMAN3, Jaana PALTAMAA4, Joanne VALERIUS5, Kaija SARANTO6, Petteri WECKSTRÖM4, Thomas MARIBO7, Heidi ANTTILA8

Pacific Rim International Conference on Disability and DiversityMay 19, 2015

1Southern Illinois University, United States of America, 2 McMaster University, Canada, 3 University of Stellenbosch, South Africa, 4 Jyväskylä University of Applied Sciences, Finland, 5 Oregon Health &

Science University, United States of America, 6 University of Eastern Finland, Finland, 7 Rehabilitation Center Marselisborg, Aarhus University, Denmark, 8 National Institute for Health and Welfare, Finland

mICF International Partnership 1

Introduction

• An estimated 15% of population experience limitations in activities and participation with 2-4% severe limitations

(World Bank & WHO, 2001)

• These needs are not easily transferred from patients to services nor interprofessionally

• Potential consumers include all people as well as all social and health care organizations in the Americas, Europe, Africa, Asia and Australia

mICF International PartnershipTwitter: @ICFmobile 2

WHO and ICF

• World Health Organization (WHO) aims at re-engineering primary health care with emphasis on community-based, person-centered care

• The International Classification of Functioning, Disability and Health (ICF), provides standardized information structure and common language across professionals, to describe the lived experience of a person’s real life situation


Current use of the ICF

• Major use has been in research on ICF• Despite many initiatives to train clinicians

worldwide, the ICF has not been used in clinical practice (across professions) for multiple reasons

• Several groups have started to investigate the feasibility of an electronic or a mobile version of the ICF in order to facilitate the clinical use

• While it is not too difficult to transfer the classification into an electronic and searchable document, this would only be part of the overall process of using the ICF clinically


A global online survey for social and health care specialists (n=1,198)

• Purpose was to assess needs requirements to develop a mICF to collect patient-centered data for clinical decision-making

• Conducted June-December 2014 in 40 countries, via a “snowball” system

• English, Afrikaans, Chinese, Danish, Dutch, Finnish, French, German, Japanese, Korean, Mongolian, Portuguese (Brazil), Portuguese (Portugal), Spanish and Thai


Results from the global online survey

• Many people do not have experience in using the ICF neither in research nor in clinical practice

• Even among those who are familiar with the ICF: only 30-50% would always ask about personal or environmental factors

• Nearly all wanted to use electronic devices for collecting and reporting health data

• Most benefits were seen in improved patient care with better supported clinical reasoning, decision-making about interventions, and in monitoring functional health over time


International mICF Partnership

• An international collaborative of the Functioning and Disability Reference Group of the WHO’s Family of International Classifications Network was established to investigate the development for a mobile application for the ICF (mICF)

• Included in the WHO-FIC FDRG strategic work plan• 248 collaborators from 48 countries to develop• User-friendly ICanFunction (mICF) health service

platform to conceptualise health and wellbeing as a dynamic interaction between a person’s health condition, functioning and contextual factors


When “taking a history”

• Clinicians focus on pieces of information from various sources (patient, family, professionals) that help them to understand what is going on

• Putting many pieces together can help to make a more accurate diagnosis

• One of the challenges for clinicians is to find the balance between collecting all the right pieces of information to make a diagnosis and paying attention to the unique stories of individual patients’ daily lives

• Good patient care takes them both into account!


Linda and her son Erik

• Linda struggled with all the deprecating comments her family members made about her son Erik during the celebrations on the long weekend

• He did not eat as other kids his age, did not behave like them or play like them. Tired of all the “well-meant” advice of how to educate and raise her child and not having a diagnosis to explain easily to others Erik’s differences, …

• She started describing his strengths and struggles in the “mICF PROFILE BUILDER” to share a description of her son that might help others to better understand, accept and include him in future family gatherings


I am Erik. What works for me?

• Give me time to talk – I may take longer but I have lots to say

• Let me eat what I can, when I can … I know what foods are safe for me, and forcing me to eat won’t help

• If I am acting poorly, let my mom deal with it.

• If I get overwhelmed by sensory input (noise, sight, touch), my behaviour may look inappropriate, but it is my reaction to an overwhelming situation. Please give me time alone.


Things I am learning:• Learning to chew and swallow food;

Learning to talk clearly; Learning to play well with my friends

What I like doing:• Playing with my sister; Staying close

to mom; Running around; Pretend play with my toys; Helping mom vacuum and clean.

What is important for me?• Good sensory regulation; Proper

nutrition with PediaSure®; People who are patient with me.

What people say about me?• Busy; Adorable; Smart; Funny;

Hyper; Small; Doesn’t eat; Hard to Understand

Short profile captures Erik’s difficulties and strengths

09-05-2015 mICF International Partnership 11

Erik’s profile ICF items ICF codesGive me time to talk – I may take longer but I have lots to say

Articulation functions b320

Let me eat what I can, when I can … I know what foods are safe for me, and forcing me to eat won’t help

Ingestion functionsSwallowingIndividual attitudes of extended family members

b510b5105e415

If I am acting poorly, let my mom deal with it.

Managing one's own behaviourIndividual attitudes of immediate family members

d250e410

If I get overwhelmed by sensory input (noise, sight, touch), my behaviour may look inappropriate, but it is my reaction to an overwhelming situation. Please give me time alone.

Handling stress and other psychological demandsSound qualityLightTactile perceptionAuditory perceptionVisual perceptionIndividual attitudes of extended family members

d240e2501e240b1564b1560b1561e415

mICF International Partnership09-05-2015 12

Erik’s profile ICF items ICF codesLearning to chew and swallow food

ChewingSwallowing

b5102b5105

Learning to talk clearly Articulation functions b320Learning to play well with my friends

Shared co-operative play d8803

Playing with my sister Shared co-operative play d8803Staying close to mom Physical contact in relationships d7105Running around Running d4552Helping mom vacuum and clean

Helping to do housework d6406

Good sensory regulation Perceptual functions b156

Proper nutrition with PediaSure®

Food e1100

People who are patient with me

Attitudes e4

Busy Energy and drive functions b130Adorable Personal factor Personal strengthSmart Personal factor Personal strengthFunny Personal factor Personal strengthHyper Energy and drive functions b130Small Height percentileDoesn’t eat Appetite b1302Hard to Understand Articulation functions b320

Based on the underlying coding with ICF

• Linda was able to get a nice printout to be shared with her relatives

• Sharing the anonymised profile on the “mICF WEBSPACE” revealed that there was another boy with similar issues living in the same town

• His parents had uploaded his profile on the protected webspace and also indicated that he benefitted significantly from using text-to-speech software that not only helped him learn to read but through the voice recognition software was also able to provide feedback to their son on his articulation, helping him to improve his intelligibility in a playful and non-judgmental way

Twitter: @ICFmobile mICF International Partnership 13

Connection with others

• She decided to connect with this family over the secure chat to obtain more information

• By using the App this mother was able to better articulate her son’s needs and strengths and also obtain automatic recommendations based on the functional profile of her son

• If parents try to find help for their children on Webpages or in chat rooms they usually feel overwhelmed by the deluge of information and the need to filter out what is applicable to their own child and their specific family needs


Approach – mobile ICanFunction App (mICF)

• Easy to use, safe mobile solution for all people • A person can share his/her own functional needs

(problems and strengths) and thus ease the conversation with professionals

• The professionals get easy and quick summary for the rehabilitation or service plan, and can follow-up changes

• Minimize need for repeat data collection: time-savings• A solution that bases on international standard to

describe each person’s functioning as a dynamic interaction between the person’s health condition, functioning, and environmental and personal factors comprehensiveness, transferability


How will mICF be developed?

• Data will be patient-driven, facilitating shared decision-making and well-coordinated, holistic, continuity of care across various service settings

• Personal health data will be processed securely, informing a patient-empowering bio-psycho-social approach

• Big data analytics will enable personalised, predictive care

• Proof-of-concept validation across the globe include low-and middle income countries



• Clinical studies will focus on older people, as well as children and adults with chronic diseases

• State-of-the-art service design will entail iterative in-market experimentation, and impact and economic evaluation

• An extensive dissemination strategy, in close collaboration with the International mICF Partnership, will focus on change management, allowing new patient pathways and interprofessional collaboration

• Lean, agile commercialization will ensure sustainability and the development of new business and service solutions adhering to ethical and legal regulations


Funding Initiatives

mHealth solution based on International Classification of

Functioning, Disability and Health

The mobile ICanFunction App (mICF)

Horizon 2020 PHC-25 CallCoordinator: THL3,5 years: 1.1.2016-30.6.2019

Twitter @ICFmobile

Facebook ICanFunction

micf - mobile icanfunction app

Health & Medicine

health icf

icf world health organization

mobile icf micf technology

health care organizations

icf major use

clinical use

aarhus university

university of eastern