D - MobiHealth
Contents
1. The problem of linking the BAN and the patient s id has been enhanced since the BAN identification number is not easily visible In order to see it the GPRS jacket must be removed If this embarrassing step wants to be skipped there are some solutions like a post it or a table which crosses the BAN id with the BAN number i e outdoors9 already in a post it It is obvious that none of these solutions named above are suitable for a proper and easy use of the system This is the reason why it should be mandatory to take some of the decisions explained underneath 29 44 When the professional enters Portilab and wants to see the data of a patient she he has to know with which BAN and the exact time beginning and ending the measurements have been produced Moreover the measurements are not displayed chronologically by hour not by day As you can appreciate the day and some other information is not visible in the menu To know exactly which measurement we want we have to go to a TME site were they are displayed There is another cause of concern after a few measurements the list will be endless and thus confusing The possibility to structure or delete measurement should be available The professionals have the feeling of a lack in terms of usability from the clinical point of view Most of their suggestions have not been followed and this makes it really difficult to make a good evaluation of the product or even impossibl2. Sweden Trial 1 The Lighthouse alarm and locator Not tested because the input data was not seen in the Portilab at the time of the trial although it was apparently sent A later investigation by Paul Buysmans in Twente determined that two packets of data had arrived Trial 2 Physical activity and impediments to activity in women with Rheumatoid Arthritis There are many steps involved in using the activity list i e choosing the activity and then sending Except for that it works well although one can sometimes forget to send the data so a reminder to send light or sound after data has been entered would be useful Trial 3 Monitoring of vital parameters in patients with respiratory insufficiency When filling in the manual input activity list it was easy to forget that one had to press the action button to send the activity to the BES There were many steps to remember Trial 4 Home care and remote consultation for recently released patients in a rural area This worked fine and was easy to use during the test Spain Trial 1 Support of home based healthcare services No experiences were recorded here Trial 2 Outdoor patients rehabilitation No experiences were recorded here The Netherlands 26 44 Trial 1 Tele Trauma Team There was no pre trial in this area Trial 2 Integrated home care for women with high risk pregnancies We made no use of it Because of the main communicatio
3. are fit well ECG 1 3 is presented accurately It is necessary to zoom in the viewer in order to see meaningful data Data can be interpreted broadly not in detail with a scale as the medical responsible person said Sweden Trial 1 The Lighthouse alarm and locator The Sensor view window displayed no ECG or activity curves but the marker for alarm and saw signal were visible Trial 2 Physical activity and impediments to activity in women with Rheumatoid Arthritis No sensor signal could be seen on the sensor viewer Trial 3 Monitoring of vital parameters in patients with respiratory insufficiency ECG pulse oximetry and activity could not be viewed in the sensor viewer Restart was attempted but unsuccessfully not even on 22 9 when data was sent for 40 minutes Again there was no advice from the user manual for iPAQ only for using PC and direct connection with Bluetooth to Mobi which should not be used in the Swedish trials In the overnight continuous trial the activity sensor seemed to work sufficiently This was valid for both step registration and body level registration The pulse oximeter worked fine There was no valid signal from the ECG the data seemed to consist of spikes over amplified signal Only the EXG1 and EXG2 sensors were represented and never the third EXG Trial 4 Home care and remote consultation for recently released patients in a rural area The ECG showed a signal with
4. been called and they have agreed to participate The maximum number of patients will be five Trial 3 Monitoring of vital parameters in patients with respiratory insufficiency As soon as Version 3 1 is delivered Pre Trial 2 will start Two persons healthy who are willing to participate as test persons and the physiotherapist also has two or three test persons healthy After Pre Trial 2 there will be an evaluation and a new report as in Pre Trial 1 Concerning a real trial if the system is found to be stable enough and working very well a real trial can be performed within a week of evaluating 3 1 but not if Version 3 1 is evaluated and tested as mentioned above If it is so we will test on more healthy pre selected COPD patients 41 44 Trial 4 Home care and remote consultation for recently released patients in a rural area Our plan is to do Pre Trial 2 as soon as Version 3 1 is delivered and working Directly after Pre Trial 2 we start the real trial Everybody involved is informed and we start with real patients as soon as everything works OK Spain Trial 1 Support of home based healthcare services As soon as we receive the new version 3 1 we will proceed to do Pre Trial 2 Once we make sure that the system is reliable enough the next step will be the real trial The conditions for doing the real trial are just having a secure enough system for dealing with patients Trial 2 Outdoor patients r
5. earlier used an early version of the manual while later trials used an improved version with far more transparency and user friendliness In summary this pre trial succeeded in showing the areas and features of the system which have room for improvement and in most cases at time of publication the systems providers have indicated that these improvements have already been or are already being implemented in Version 3 1 A further report evaluating the performance of the prototype Version 3 1 in Pre Trial 2 will be written with an extra chapter devoted to comparison of the two versions with a view to assessing the above mentioned improvements in functionality data transfer and ease of use 44 44
6. heart disease 9 September 299 September 2003 preparation trying out the BAN equipment with staff only limited communication tests getting the BAN up and running familiarising staff with Portilab accessing measurements 50 hours Following this tests were done with two patients lasting a total of circa six hours Sweden Trial 1 The Lighthouse alarm and locator 2 October 1 hour 3 October 1 hour and 8 October 3 hours 2003 Trial 2 Physical activity and impediments to activity in women with Rheumatoid Arthritis g September 12 September On the ge September the test ran from 8 30 to 16 00 on the 9 to the 12th from 9 00 to 16 00 each day On gn September a volunteer tested the BAN and from 9 to 12 only the activity sensor was trialed not the ECG Trial 3 Monitoring of vital parameters in patients with respiratory insufficiency an September 1 hour Tth 8 September 17 hours continuously overnight 20 21 September in total 6 hours 22 September 2 hours 2003 Trial 4 Home care and remote consultation for recently released patients in a rural area 10 11 August 26 September 29 and 30 September 2003 approximately four hours a day Spain Trial 1 Support of home based healthcare services End of August until end of September 2003 The testing was done each day periodically during the morning and lasted around four hours every day Trial 2 Outdoor patients rehabil
7. in a rural area Was not tested due to theft of the machine which contained the software from the doctor who was testing At the time of Pre Trial 1 this was the only computer with Portilab installed Spain Trial 1 Support of home based healthcare services Since the data and the plc configurations were not compatible between Portilab1 and Portilab2 not many examples and situations were tested before the BANs delivery Still important comments about the Portilab2 application are discussed 28 44 It is not mentioned that Portilab2 does not work under any version of Windows OS For instance Portilab2 will not run under Windows NT Such consideration must be taken into account and spread by the programmers since time can be saved Patients section It is a cause of concern that the application does not provide any tool to link a patient ID with a BAN ID It is known that the association patient BAN is not unique a patient can be monitored with different BANs in different measurements and the same BAN can be used for different patients It depends on the trial But when a professional needs to load a data file from a specific patient he she has to know the BAN ID plus day and hour of the measurement From a clinical point of view this is not efficient because that means that the nurse doctor has to write down a 12 character ID and enter it in the application Portilab2 Moreover the nurse or doctor might need to monit
8. signs from a person at home to an Registered Nurse and or a physician for consultation and diagnosis in order to reduce visits to the hospital and give trustful and safe care at home A subsequent aim is to use this methodology and evaluate the consequences in terms of experiences of healthcare and living at home with severe illness quality of life ethical considerations etc and also evaluate the consequences for the Nurse Aids Licensed Practitional Nurses and Registered Nurses in their work Jn this pre trial two professionals tested the system in several different environments at home in a healthcare department and in a car driving over a wide rural area Spain Trial 1 Support of home based healthcare services The end resulting trial involves use of GPRS for supporting home based care for elderly chronically ill patients usually suffering from more than two concurrent conditions The MobiHealth Nurse BAN will be used to perform patient measurements during nurse home visiting This pre trial involved technical and medical personnel only and was run exclusively in the hospital and between the hospital and the telecommunications services Trial 2 Outdoor patients rehabilitation In the scenario description for the trials as originally designed the patients involved in this trial are chronic respiratory patients who could benefit from rehabilitation programmes to improve their functional status The study aims to check feasibili
9. spikes this was not working as it should There was no valid signal from the ECG EXG1 and EXG2 were represented but never EXG3 The signals could not be used by a healthcare professional Pulse oximeter works fine with the parameters showing on the screen Spain Trial 1 Support of home based healthcare services 24 44 The results presented in the IPAQ do not permit a correct interpretation The display of numerical results is satisfactory but the graphics are useless since no scale is available The professional cannot base his her whole evaluation on this information As a conclusion we must say that the interaction with the IPAQ should be much more simple stable and user friendly Trial 2 Outdoor patients rehabilitation Same as section for Spain Trial 1 immediately above The Netherlands Trial 1 Tele Trauma Team There was no pre trial at this stage Trial 2 Integrated home care for women with high risk pregnancies Because of the communication problem between BAN and iPAQ this group focus on data transmission and did not concentrate in this stage on the other performance criteria 25 44 Manual input Germany Trial 1 Secondary prevention in coronary heart disease Sending of data by manual input does not work there was no help desk function available at the time The software in the iPAQ seems to work all right but there is no way of knowing if the data arrives and no way of knowing if it is displayed
10. 1 Secondary prevention in coronary heart disease The next pre trial will occur as soon as the upgrade is installed If an upgrade is not delivered a real trial will be done with two patients using the 3 0 system with GPRS Sweden Trial 1 The Lighthouse alarm and locator If Version 3 1 is delivered in mid November and works very well we will do Pre Trial 2 It is going to be done as soon as possible after the upgrade is ok A real trial will then be in Week 48 Test persons have been informed and agreement is signed They are ready and waiting So it looks good from The Lighthouse side Preconditions for being able to do a proper trial would be that the start up is easier and more automatic Functionality should be able to keep the GPRS connection up We expect better applications for technical tests on the iPAQ itself better logging functions and overall improved stability PortiLab needs improvement For this particular trial there is the requirement for GPS in the BAN There is also the enquiry whether there can be an SMS messsage from the Back End system to the mobile phones when the alarm goes off There is a need for a better battery capacity regarding the GPRS part of the system Trial 2 Physical activity and impediments to activity in women with Rheumatoid Arthritis We will do a Pre Trial 2 as soon as the system is upgraded the next day after it has been delivered and someone has installed it Two patients have
11. DYA a ae JIN Informati pS ociety European Commission M 0 B H EA LTH IST Programme Project Number IST 2001 36006 Acronym MobiHealth A project funded by the European Community under the Information Society Technologies Programme 1998 2002 Pre Trial User Evaluation Report Pre Trial 1 August September 2003 Editor Anita Melander Wikman LTU SE Maria Jansson LTU SE Tony Scully LTU SE Authors Albert Alonso CSC ES Anna Lena Andersson LTU SE Staffan Andersson LTU SE Susanne Andersson LTU SE Agneta Granstr m LTU SE Monica Hansson LTU SE Peter Lems UTwente NL Stefan Roedig GScout 24 DE Barbara Vallespin CSC ES Irene Vikman LTU SE Preparation Date October 21 2003 Version Version 1 7 final Contract Start Date May 01 2002 Duration 22 months February 2004 Project co ordinator Rainer Herzog Ericsson GmbH ADD D PreTrialOne Report_WP5_LTU_Version1 7_20031021 Contents Executive Summary Part One Field Pre Trial Details per Trial Site Testing period Location of test all locations where BAN was tested data read Person s testing BAN BAN Mobi serial number iPAQ model and extras Sensors tested parameters measured Part Two Outcome Assessment Activating iPAQ Sending Mobi iPAQ Back End system communication Sensor view on iPAQ Manual input Portilab Part Three Usability and Empowerment Functionality Eas
12. and Staffan Andersson in the countryside and in the city centre of Lulea Trial 4 Home care and remote consultation for recently released patients in a rural area There were five pre trials Test 1 and 2 in Boden Test 3 in a private home in Storsand north of Boden Test 4 in Lulea and Test 5 in a car driving from Storsand to Boden for 45 minutes Spain Trial 1 Support of home based healthcare services The BANSs were tested in the Clinic hospital in Barcelona The data was sent to the server placed in Telef nica Madrid and then the access to the information was done from portable PCs also at the hospital Barcelona Trial 2 Outdoor patients rehabilitation The BANSs were tested in the Clinic hospital in Barcelona The data was sent to the server placed in Telef nica Madrid and then the access to the information was done from portable PCs also at the hospital Barcelona 8 44 The Netherlands Trial 1 Tele Trauma Team There was no pre trial at this stage Trial 2 Integrated home care for women with high risk pregnancies e at the hospital e at home with pregnant women This pre trial tested 10 women at the hospital and two when they were at home The 10 hospital patients were monitored at the birth centre of Medisch Spectrum Twente in Enschede under the supervision of a gynaecologist 9 44 Person s testing BAN Germany Trial 1 Secondary prevention in coronary heart disease Professionals Bae
13. belt and placed to one side during the night The ECG cables were disconnected during the night but then no trials in Sweden will use overnight registration with ECG electrodes 31 44 Trial 4 Home care and remote consultation for recently released patients in a rural area The BAN was carried around without any problems also no problems were experienced with driving the car The sensors were easy to use and the test person had no difficulties with them at all It was possible to perform activity in daily life Spain Trial 1 Support of home based healthcare services Not very user friendly as stated above the percentage of success in terms of GPRS connection and data storage is pretty low Trial 2 Outdoor patients rehabilitation Same as section for Spain Trial 1 immediately above The Netherlands Trial 1 Tele Trauma Team There was no pre trial in this area Trial 2 Integrated home care for women with high risk pregnancies The women colleagues that carry the BAN are enthusiastic The BAN is light to carry and the stickers cause no trouble The wires from stickers to BAN are too long The women can imagine that staying at home with this equipment and being monitored at a distance is a great service Because they are healthy pregnant women it is always difficult to answer the question of safety in case they were high risk pregnant women 32 44 Ease of use Germany Trial 1 Secondary prevention in coro
14. by one trial owner in the Lighthouse and one test person in the city Trial 2 Physical activity and impediments to activity in women with Rheumatoid Arthritis The aim of the trial is to follow the patients activity level during the course of a week by means of continuous monitoring of heart rate and self reporting of the activity level monitoring walking distance to determine the factors that impede the patient from performing those activities that she wishes to perform The primary research question is to examine the correspondence of heart data and monitored activity to the self reports of activity level It is also intended to evaluate how the women experience using the mobile technological devices In this pre trial the trial owner tested the system with a colleague Trial 3 Monitoring of vital parameters in patients with respiratory insufficiency The end trial is to examine whether mobile health facilities with monitoring of some relevant vital signs can contribute to an earlier detection and treatment of COPD and also reduce the need for check ups and hospitalisation In this pre trial two professionals and one test person wore and tested the unit off and on over several days performing different activities One trial owner wore the BAN system continuously for 17 hours Trial 4 Home care and remote consultation for recently released patients in a rural area The end goal of this trial is to find a way to communicate vital
15. cation has different states such as de activated un registered sending The states are communicated to the user through a text message and are linked with the state of the button Start Stop After many essays we conclude that the application is not stable the sequence of states is unpredictable for the same inputs In other words the application only ends working properly i e sending the measured data in around 20 of the cases As you can imagine working in such conditions becomes frustrating It is complicated for a health care professional to deal with such poor material but impossible for a patient elderly who generally has fewer contact with technology The battery of the device must be full or almost if we don t want the communication to fail more than it has been said The IPAQ has to be almost connected most of the time The mobility is then reduced Trial 2 Outdoor patients rehabilitation Same as for Spain Trial 1 immediately above The Netherlands Trial 1 Tele Trauma Team There was no pre trial at this stage 22 44 Trial 2 Integrated home care for women with high risk pregnancies In earlier experiments data were sent from the iPAQ to the Back End system This data stream is ok No trouble was experienced in getting the data by internet out of the server UT on the portable computer 23 44 Sensor view on iPAQ Germany Trial 1 Secondary prevention in coronary heart disease If sensors
16. devices Until now patients were colleagues and only two of them used it at home With a lot of sending trouble 34 44 Safety Germany Trial 1 Secondary prevention in coronary heart disease The system is not yet reliable enough to be considered safe It is not possible to make clinical decisions with the system at this stage of development Sweden Trial 1 The Lighthouse alarm and locator Not a safe system today given the breakdowns in communication and the habit of the Mobi to switch itself off Trial 2 Physical activity and impediments to activity in women with Rheumatoid Arthritis The system is not safe as it works today as it is so unstable The text and the icon on the MBU cannot be trusted there is noting which indicates when the communication system has gone down Trial 3 Monitoring of vital parameters in patients with respiratory insufficiency A test person in the pre trial said she did not have trust in the BAN as it was today As the system works today she would not prefer to wear it herself Trial 4 Home care and remote consultation for recently released patients in a rural area The BAN is at this moment in the trial process not safe to use The ECG curve cannot be interpreted and the data cannot be sent safely when it is unknown whether the parameters are showing correctly on the sensor view or Portilab A security code for the system has not yet been implemented additionally a login on the
17. e in some trials to make use of the system As an example of this it would have been absolutely necessary and it was said from the very beginning of the design phase that the name of the patient and other eventual information was directly inserted on the iPAQ during the measurement The presentation of the results and measurements is also poor The measurements cannot be evaluated without a scale The data interpretation is not possible The data storage option allows the storage of part of the measurements The data is stored from the beginning until the stop button is pressed It would be interesting to decide when we want the data to begin to be stored Trial 2 Outdoor patients rehabilitation Same as section for Spain Trial 1 immediately above The Netherlands Trial 1 Tele Trauma Team There was no pre trial in this area Trial 2 Integrated home care for women with high risk pregnancies Jan Peuscher of TMSi is working on it He perfected the Portilab software We use this software and are satisfied about the results We see what we want to see 30 44 Part Three Usability and empowerment Functionality Germany Trial 1 Secondary prevention in coronary heart disease Using the BAN takes a lot of practice and patience The largest problems are GPRS connection and the usability of the iPAQ software sending data mode Sweden Trial 1 The Lighthouse alarm and locator It was not at this point
18. e of use Safety Mobility Part Four Other Comments Part Five Preconditions for Further Trials Part Six Conclusions MobiHealth_LTU_WPS5 _ PretrialOne_V1 7_ 20031021 2 44 Executive Summary This document reports on the results of the first pre trial of the MobiHealth project from the perspective of the trial owners A trial owner is the doctor nurse physiotherapist administrator and technical provider involved in putting together and running the trial A trial is a field test of the MobiHealth Body Area Network prototypes and the necessary communications infrastructure The trials follow the guidelines outlined in Deliverable 1 4 of the project That deliverable determines the methodology used for evaluating the field trials Running over the summer and mainly in the month of September 2003 Pre Trial 1 of the MobiHealth prototype tested Version 3 0 of the BAN in trials running in Barcelona ES Moenchengladbach D Enschede NL Lulea and Boden SE It was the purpose of this pre trial to familiarise trial owners and in a limited way their clients patients care recipients with using the BAN and communications to evaluate the performance and user friendliness of the equipment and to provide data to the system providers for upgrading their prototype to Version 3 1 In turn Pre Trial 2 scheduled for November will evaluate the enhanced performance of Version 3 1 of the BAN in similar field tests in the same regions The pro
19. e problem was to turn it off the iPAQ is always on even in the cradle Spain Trial 1 Support of home based healthcare services The application and the system do not seem to be very stable the communications often fail Being more specific the main problem relates to the establishment of the GPRS connection and the transmission of the data from the iPAQ to the Back End system In order to make sure that the GPRS connection has successfully been established you have first to restart the iPAQ Then when it starts running you have to take the iPAQ out and in from the GPRS jacket Once this has been done it is still necessary to test that the communication is properly established In order to do so it is necessary to open the command screen in the iPAQ and enter the following line ifconfig ppp0 obtaining a long technical message which tells if the connection is working or not The actual meaning of the message should not be considered by the user Rather he only checks that it is a long one If the previous steps have been successful and in order to send the sensor s data from the iPAQ to the Back End system you have to press the send data button on the iPAQ s screen However this doesn t mean that data are being successfully transmitted In our measurements we found that only 20 of the time this works properly In the remaining 80 of the cases the data never get stored at the Back End system Trial 2 Outdoor pati
20. e the iPAQ had to be reset several times Bluetooth and GPRS at least as far one could see in the status announcement on the MBU were working and sending There is no information whether communication was successful or useful data was received Trial 2 Physical activity and impediments to activity in women with Rheumatoid Arthritis From the Mobi to the iPAQ about 75 of the time when the iPAQ and Mobi were started up the blue icon which should indicate that the Mobi is sending to the iPAQ came up on the screen From the iPAQ to the Back End system 95 of the time there was no apparent connection between the iPAQ and the Back End system that is there was no text on the iPAQ reading Status MBU is sending Trial 3 Monitoring of vital parameters in patients with respiratory insufficiency During 20 21 9 there was no success in contact with the Back End system since it was shut down The Mobi turned off spontaneously several times during 20 22 9 The test person had to check if the Mobi was on all the time During start up procedure the iPAQ had to be reset several times Bluetooth and GPRS were working It was considered to be a problem not to be able to know that the Back End system was up and running This was considered to be a great advantage to know In the overnight continuous trial start up failed more than ten times indicator of no connection and command to check the Mobi There was a spontaneous disconnection fiv
21. e times and the Mobi spontaneously turned off twice The battery duration on the Mobi was approximately 20 hours Trial 4 Home care and remote consultation for recently released patients in a rural area 21 44 Back End system not tested Because a good Portilab manual had not yet been written for the medical people it was very difficult to check if they had got any test data on the Back End system by using the PortiLab application We tried but we were not able to get any connections with the Back End system during Pre Trial 1 We think the reason was that the Back End system was not running After the Pre Trial 1 period we were able to have connections with the Back End system and then it worked Spain Trial 1 Support of home based healthcare services The IPAQ s software appears as the weakest link of the system Several problems were detected The connectivity between the IPAQ and its GPRS jacket is not reliable The IPAQ needs to be rebooted almost after each data transmission Rebooting the device implies connecting the GPRS jacket at the right moment inserting the password and restarting the application Doing it once or twice it is not such a big deal but being a professional or a patient and repeating the procedure many times a day The Start Mobihealth application is very poor On the left hand side 2 icons appear and disappear do they give any kind of information The following aspect is more critical The appli
22. ehabilitation As soon as we receive the new version 3 1 we will proceed to do Pre Trial 2 Once we make sure that the system is reliable enough the next step will be the real trial The conditions for doing the real trial are just having a secure enough system for dealing with patients The Netherlands Trial 1 Tele Trauma Team No information Trial 2 Integrated home care for women with high risk pregnancies If the communication problems are solved and we have 5 BANs we can test the stability of the system If we start half November we have 3 5 months to test it We can then monitor as many women as we want because we can vary the length of the period a women carries a BAN Only when the communication system is stable can we evaluate all the other aspects of the trial user friendliness of the equipment data sending when the patient is mobile lifetime of the battery etc 42 44 Part Six Conclusions This pre trial generated useful feedback for the system providers to use in the current upgrading and fine tuning phase of the Body Area network and GPRS UMTS connectivity While some characteristics were specific to an individual pre trial there was quite a lot of overlap in the experiences of the trial owners in different regions of Europe and the partners could see a great deal of commonality to the issues which are now being addressed in the development of Version 3 1 A few are noted below Start up it is a general requiremen
23. ents rehabilitation Same as section for Spain Trial 1 immediately above The Netherlands Trial 1 Tele Trauma Team There was no pre trial at this stage Trial 2 Integrated home care for women with high risk pregnancies The capacity of the battery is a problem but activating the iPAQ is not a problem The BAN sends five minutes of data to the iPAQ Then it notices that the iPAQ is not turned on while it is on and the process of data sending stops Monitoring at home never lasted longer than this 5 minutes over and over 17 44 Sending Germany Trial 1 Secondary prevention in coronary heart disease The sending mode does not work sufficiently in most cases there is no connection when pushing the Start button on the IPAQ Check Mobi Device Sends data without problems in approx 10 of attempts Sweden Trial 1 The Lighthouse alarm and locator Portilab did not work in the Lighthouse care centre so it is not known if data was sending this was due to not being able to connect to the Back End server and was only a temporary fault Note A later check shows that two files were stored in the Back End system but there were only 2 and 7 minutes of data stored The first test should have been at least one hour There was no indication of communication failure to the user Trial 2 Physical activity and impediments to activity in women with Rheumatoid Arthritis On 8 September data was sent for about 50
24. est persons was clearly seen on the computer and mobile phone However the test person at the city was not found due to the fact that the application shut down when the test user playing the part of a patient in the city made a phone call The Sony Ericsson P800 can apparently not send data at the same time as you make a phone call GPRS can therefore not send data at the same time as a phone call In addition on the current system the maps are old not detailed enough to be able to find a person more modern maps where all new buildings are shown are needed Also the GPRS communication broke down during the test Also the connection with the Mobi always broke down during testing The still image is fine Presentation picture of the patient and personnel at the Lighthouse care centre was displayed when calling either from the Lighthouse or vice versa Trial 2 Physical activity and impediments to activity in women with Rheumatoid Arthritis There must be more than one test to say more about the usability as both the professional and the test person were new to this system The same test person will test the equipment again after the upgrade Trial 3 Monitoring of vital parameters in patients with respiratory insufficiency 39 44 One trial owner thought it would be good if the user manual contained a section about how to scan what was wrong the most common things for example how to know if the Back End system is shut d
25. hcare services The IPAQ s software appears as the weakest link of the system Several problems were detected The connectivity between the IPAQ and its GPRS jacket is not reliable The IPAQ needs to be rebooted almost after each data transmission Rebooting the device implies connecting the GPRS jacket at the right moment inserting the password and restarting the application Doing it once or twice it is not such a big deal but being a professional or a patient and repeating the procedure many times a day The Start Mobihealth application is very poor On the left hand side 2 icons appear and disappear do they give any kind of information This is not known The following aspect is more critical The application has different states such as de activated un registered sending The states are communicated to the user through a text message and are linked with the state of the button Start Stop After many essays we conclude that the application is not stable the sequence of states is unpredictable for the same inputs In other words the application only ends working properly i e sending the measured data in around 20 of the cases As you can imagine working in such conditions becomes frustrating It is complicated for a healthcare professional to deal with such poor material but impossible for a patient elderly who generally has fewer contacts with technology The battery of the device must be full or almost if we do not
26. iew and selecting patients Technical professionals J Peuscher of TMSi is working on the Portilab software and A van Halteren of University of Twente is working on the iPAQ 11 44 BAN Mobi serial number iPAQ model and extras Germany Trial 1 Secondary prevention in coronary heart disease Mobi SN 0924030051 IPAQ SN 4G2ADW34N07V Sweden Trial 1 The Lighthouse alarm and locator iPAQ SN 4G2ADW34N072 Mobi SN 0924030048 GPRS SN 9V36KD41AMTG GPS receiver and 2 Sony Ericsson p800s SIMs for GPRS connection provided by TeliaSonera Trial 2 Physical activity and impediments to activity in women with Rheumatoid Arthritis IPAQ SN 4G2ADW34N086 Mobi SN 0924030012 GPRS SN 9Y36KD41AMWC SIMs for GPRS connection provided by TeliaSonera Trial 3 Monitoring of vital parameters in patients with respiratory insufficiency iPAQ SN 4G2RDW34N07D Mobi SN 0924030021 GPRS SN 9434KD41KLJK SIMs for GPRS connection provided by TeliaSonera Trial 4 Home care and remote consultation for recently released patients in a rural area Mobi S N 0924030029 iPAQ S N 4G2ADW34N06W GPRS S N 9Y36KD41AMAC SIMs for GPRS connection provided by TeliaSonera Spain Trial 1 Support of home based healthcare services iPAQ S N 4G2BDW34R04S iPAQ S N 4G2BDW34R05W iPAQ S N 4G2BDW34RO05T 12 44 Mobi S N 0924030041 Mobi S N 0924030044 Mobi S N 0924030018 GPRS WLAN NOKIA D211 PCMCIA provided by the hospital CSC SIM
27. imeter plethysmogram SpO2 pulse rate Note respiration was scheduled to be tested but was not due to the lack of the appropriate sensor which had been delivered in the pre BAN but this sensor was accidentally not delivered from Enschede in this version of the BAN Spain Trial 1 Support of home based healthcare services SatO2 ECG spirometry 14 44 Trial 2 Outdoor patients rehabilitation Pulse oximetry ECG mobility The Netherlands Trial 1 Tele Trauma Team There was no pre trial at this stage Trial 2 Integrated home care for women with high risk pregnancies Heart rate of the mother Heart rate of the unborn child EMG mother Blood pressure Note Blood pressure is a variable CTG measurement is part of another home care project for pregnant women Measurements of the BAN are a substitute for CTG monitoring 15 44 Part Two Outcome Assessment Activating iPAQ Germany Trial 1 Secondary prevention in coronary heart disease We encountered problems with GPRS connection success rate 0 with some tricks inserting GPRS sleeve in the right moment etc GPRS connection is available in most cases but this takes some time and patience Not yet user friendly enough to run trial Sweden Trial 1 The Lighthouse alarm and locator The iPAQ had to be reset several times during the test The information in the user manual on how to start the iPAQ up was quite clear Note this trial u
28. itation 6 44 End of August until end of September 2003 The testing was done each day periodically during the morning and lasted around four hours every day The Netherlands Trial 1 Tele Trauma Team There was no pre trial at this stage Trial 2 Integrated home care for women with high risk pregnancies August September 2003 In this period we mainly monitored patients in the hospital The reason is that the BAN and Bluetooth sent data to the computer correctly up to a distance of a metre As soon as the iPAQ was placed in between communication failed 10 pregnant patients were monitored for several hours each 7 44 Location of test all locations where BAN was tested data read Germany Trial 1 Secondary prevention in coronary heart disease Cardiologic Office Merinus Metten PhD Moenchengladbach Medical Call Center GesundheitScout24 Duisburg Sweden Trial 1 The Lighthouse alarm and locator BAN was tested at the Lighthouse care centre and in the city centre of Lulea Trial 2 Physical activity and impediments to activity in women with Rheumatoid Arthritis The location of the test of the BAN was at the Department of Health Science Boden The test was inside the department with the test person walking around in the department during the day Trial 3 Monitoring of vital parameters in patients with respiratory insufficiency The BAN was tested in the homes of the Trial Owners Susanne Andersson
29. ject will end with the running of a third set of trials of the system at each location to take place in December 2003 and January 2004 The user evaluation is based on a questionnaire filled in by each trial owner having completed their pre trial The sections below quote directly from the answers given A brief description of each trial follows Germany Trial 1 Secondary prevention in coronary heart disease In the future trial the patient is able to transmit ECG and blood pressure via GPRS from home or elsewhere to the health call centre where the vital signs are monitored by a cardiologist The intention is that irregular patterns in these vital signs will be quickly detected and appropriate intervention can be effectuated The trials are designed to determine whether 2 5 3G wireless communications can support such services In this pre trial the unit was tested by several medical and technical personnel and one cardiac patient as well as persons at the call centre Sweden Trial 1 The Lighthouse alarm and locator The purpose of the Lighthouse trial is to test the effectiveness of a new GPRS UMTS based personal alarm and locating device for clients of the care centre especially the elderly and the personnel according to several determining factors safety convenience 3 44 empowerment of user mobility of user and improvement in efficiency of care given In this pre trial the connectivity and positioning were tested
30. minutes to the BE system On 10 12 September it was not possible to send data There was no connection to the BE and no indication on the MBU for that the text was only MBU activated not MBU sending so the interpretation of the trial owner was that it was not possible to send data Trial 3 Monitoring of vital parameters in patients with respiratory insufficiency Succeeded in reaching sending status on 22 9 According to technical personnel data was sent for approximately 40 minutes In the overnight continuous test the success rate was 0 No data was transferable to the Back End system Trial 4 Home care and remote consultation for recently released patients in a rural area In Tests 1 4 connection start up failed seven out of ten times The signal no connection check Mobi appeared After rebooting the iPAQ it started up and was transmitting at once but after ten minutes of sending the iPAQ disconnected After restarting the iPAQ the Mobi was still sending According to the display the Mobi worked during the whole test 18 44 In Test 5 while the trial owner was driving the Bluetooth light stopped and the green light indicating GPRS was blinking After reboot it did not start again It took four reboots to start The Bluetooth and green light for GPRS functioned but the Mobi did not connect The trial owner tried to start the iPAQ 6 times without result Spain Trial 1 Support of home based healt
31. n problems between BAN and iPAQ we did not focus on manual input It is not excluded 27 44 Portilab Germany Trial 1 Secondary prevention in coronary heart disease The display is okay ECG signals seem to be valid ExG 1 ExG 2 and ExG 3 are presented Marker button is working mobility is presented in a proper way A medical evaluation can be done Sweden Trial 1 The Lighthouse alarm and locator It has not been possible to get through to Portilab and view the possibly sent files this is probably due to a breakdown in communication with the Back End system Trial 2 Physical activity and impediments to activity in women with Rheumatoid Arthritis Files were recorded from the BAN but on clicking on files no signals could be seen when accessing Portilab Note it would be an interesting way of starting PortiLab and get the data presented for the user if we could just click on a file from the browser However this functionality had never been planned to do it this way today several complicated steps through PortLab are necessary Trial 3 Monitoring of vital parameters in patients with respiratory insufficiency One trial owner was not able to get in to Portilab and view her file Files had been recorded for view in a demonstration at Telia s headquarters on gt September but on that occasion also no actual signals could be demonstrated Trial 4 Home care and remote consultation for recently released patients
32. nal or sign if the iPAQ was disconnected or not functioning properly Security in this version of the BAN and Mobi security has not yet been addressed this was planned and the security upgrade is scheduled for Version 3 1 43 44 Logging functionality this was not built into this version but once again this feature is planned for Version 3 1 General stability issues tendencies to break off communication to shut down or even stay switched on were noted These are projected to be removed in the bug fixes which are coming with Version 3 1 Portilab in general this needs serious upgrading and tailoring to the specific use in MobiHealth and an illustrative clear step by step manual would be needed Records tend to not have a chronological order for example One anomalous comment was from MST on the pregnancy trial they mention that they are satisfied with the Portilab system It would be helpful to analyse why Portilab is successful there This work is understood to be in progress and will be more usable in Version 3 1 Manual input there were calls for increased user friendliness too many steps to follow and sometimes one forgets to send because of the complexity These have already been addressed in the work for Version 3 1 User manual there was difference of opinion on this with some partners finding the manual useful and others becoming confused by it The main reason for this difference is that those trials held
33. nary heart disease The BAN front end and sensors seems to be wearable and convenient by carrying it in the little bag Putting on the sensors is no big problem for patients after a little training Sweden Trial 1 The Lighthouse alarm and locator Applying the sensors on the test person is time consuming but is quite easy It takes too many steps to start up and to use the iPAQ If a button on the iPAQ is pressed by mistake with the stylus there is no immediate information on how to get back The Mobi s on status must be periodically checked and this is advisable because it turns off very often The manual is easy to understand this is the latest version 1 6 Swedish The sensors do not feel uncomfortable Trial 2 Physical activity and impediments to activity in women with Rheumatoid Arthritis If things go well a connection between all the equipment is made the first time on start up and then the equipment is relatively easy to use In this pre trial the manual input on the activity list is the most tricky thing to do because there are many steps to take Another issue is that the text is small which can be a problem for patients Trial 3 Monitoring of vital parameters in patients with respiratory insufficiency It takes some time to apply the sensors on the test person but is quite easy There are too many steps to start up and to use the iPAQ If one by mistake pushes a button on the iPAQ with the pen it is
34. not indicated how to get back to where one was the moment before In order to know if the Mobi is still on it has to be checked now and then and it turns off all the time Switching between the different windows did not work In the overnight continuous trial several activities were easily possible to perform while using the unit even with all the equipment on the body including the iPAQ GPRS sleeve in one s pocket making a sandwich eating and drinking toilet visits walking and running and gardening One small complaint was that at night the screen light was disturbing Note there is possibly a solution to this It could be changed in configuration of the iPAQ Light stay off when iPAQ in cradle Trial 4 Home care and remote consultation for recently released patients in a rural area 33 44 The BAN is easy to use The screen and icons on the iPAQ are easy to understand The instructions were good except for Portilab Spain Trial 1 Support of home based healthcare services It is definitely not easy to use for a professional in the first pre trial but it is impossible for a patient to deal with the iPAQ the way it works now in a real trial Trial 2 Outdoor patients rehabilitation Same as section for Spain Trial 1 immediately above The Netherlands Trial 1 Tele Trauma Team There was no pre trial in this area Trial 2 Integrated home care for women with high risk pregnancies The patients can use the
35. or more than one patient at once or visualize different measurements at the same time When working in real time the need is obvious If the nurse or doctor works with recorded data he she may also need to compare data between patients or even data from the same patient with pre recorded measurements This option is not available in the current version of Portilab2 A basic solution would have been to open the application as many times as patients or measurements were to be monitored but this would not work the application does not seem to be very stable working this way Configuration section A remark has to be mentioned concerning the import of new configurations plc in the configuration section It is not a major problem but it can provoke a waste of time The fact is that the manoeuvre of importing a new configuration is far from intuitive The button conceived to achieve the import of the plc is apparently the add button in the right hand corner of the screen But it isn t If a new configuration has to be imported the mouse pointer has to be in the grey zone and by pressing the right button a menu gives the possibility to import a new configuration It is clear that the import can be done but the way of doing it is not intuitive There is another way of entering a new configuration applying when a new configuration has been created not imported The plc has to be saved in a concrete path which is not given
36. own or if by mistake the wrong button was pushed how to get back Other details to be asked were how long it took to charge the battery on the iPAQ and how to switch between windows on the iPAQ Trial 4 Home care and remote consultation for recently released patients in a rural area There should be some kind of icon or hourglass on the screen on the iPAQ to show when the iPAQ is working Also an indication is needed to show if the iPAQ can reach the Internet and the Mobi is really sending anything to the Back End system Spain Trial 1 Support of home based healthcare services Apart from the design aspects the system reveals a high instability In its current state and even for field trials the system is non reliable and non user friendly enough to be acceptable both for safety and ethical reasons Trial 2 Outdoor patients rehabilitation It is mandatory for this trial to have on line measurement of the vital signs At the moment we don t have this option available and this makes very complicated to go on with the trial The Netherlands Trial 1 Tele Trauma Team No information Trial 2 Integrated home care for women with high risk pregnancies The group underestimated the technical problems We are ready for months and have enough pregnant women to work with us in the experiment But it takes too long before we have a good technical system 40 44 Part Five Preconditions for Further Trials Germany Trial
37. possible to test the whole system as it was meant to function no access to Back End system with Portilab no confirmation therefore of data arrival The whole system seems too unstable to test on real patients at this point Trial 2 Physical activity and impediments to activity in women with Rheumatoid Arthritis The test person stated that it was convenient to carry the Mobi and iPAQ The equipment did not hinder the person in his job as a teacher For the professional it is difficult to say something about the functionality before being able to see how the data is presented in Portilab Trial 3 Monitoring of vital parameters in patients with respiratory insufficiency One trial owner states that up until today it is not possible in her opinion to receive signals from the sensor data that are of use for her in her daily work as a physiotherapist She could not determine whether the signals data that she received were correct and did not know how to interpret them She believed the whole system seems too unstable to use on real patients Another tester stated that the Mobi carried in the belt was most convenient and also provided the best facilities for good registration from the activity sensor when mounted on top of the Mobi The pulse oximeter with the IR sensor on the left ring finger was very convenient with no problems to wear it overnight The cables were long enough to allow the Mobi to be disconnected from the
38. rbel Krell Merinus Metten Christian Hund Stefan Roedig Patient Michael Dahlmanns Sweden Trial 1 The Lighthouse alarm and locator Professionals Anna Lena Andersson Stefan Kullberg Maria Porsberger Eeva Kajsa Nilsson Trial 2 Physical activity and impediments to activity in women with Rheumatoid Arthritis One professional person tested the BAN with a test person at the Department of Health Science Trial 3 Monitoring of vital parameters in patients with respiratory insufficiency A healthcare professional himself Staffan Andersson and an independent tester instructed by another professional Susanne Andersson Trial 4 Home care and remote consultation for recently released patients in a rural area Two professionals Monica Hansson Agneta Granstr m Spain Trial 1 Support of home based healthcare services There were two technicians testing the BANs and the global system plus two professionals evaluating the results and the measurements done by the sensors Trial 2 Outdoor patients rehabilitation 10 44 There were two technicians testing the BANs and the global system plus two professionals evaluating the results and the measurements done by the sensors The Netherlands Trial 1 Tele Trauma Team There was no pre trial at this stage Trial 2 Integrated home care for women with high risk pregnancies R Quartero gynaecologist and C Sluimer resident gynaecology from the medical point of v
39. s for GPRS connection provided by Telef nica M viles Trial 2 Outdoor patients rehabilitation iPAQ S N 4G2BDW34R048S iPAQ S N 4G2BDW34R05W iPAQ S N 4G2BDW34RO05T Mobi S N 0924030041 Mobi S N 0924030044 Mobi S N 0924030018 GPRS WLAN NOKIA D211 PCMCIA provided by the hospital CSC SIMs for GPRS connection provided by Telef nica M viles The Netherlands Trial 1 Tele Trauma Team There was no pre trial at this stage Trial 2 Integrated home care for women with high risk pregnancies At time of publication the equipment was at the house of a patient The written documentation was unavailable temporarily as it was in the case of the resident who was on leave 13 44 Sensors tested parameters measured Germany Trial 1 Secondary prevention in coronary heart disease ECG 3 lead Marker Alarm button Movement sensor Manual input of blood pressure levels Sweden Trial 1 The Lighthouse alarm and locator Activity drop sensor 3 lead ECG heart rate Alarm button GPS position Camera still image Trial 2 Physical activity and impediments to activity in women with Rheumatoid Arthritis 3 lead ECG Activity sensor Trial 3 Monitoring of vital parameters in patients with respiratory insufficiency Activity sensor 3 lead ECG heart rate Pulse oximeter SpO2 pulse rate Trial 4 Home care and remote consultation for recently released patients in a rural area 3 lead ECG Pulse ox
40. sed the translated version of the latest manual version 1 6 Swedish based on version 1 3 English unlike the other Swedish trials who used a slightly earlier version this demonstrates an already considerable improvement in the user manual The battery on the MBU iPAQ and GPRS jacket did not have a long life At times the iPAQ could not be turned off Trial 2 Physical activity and impediments to activity in women with Rheumatoid Arthritis The iPAQ and the GPRS sleeve had to be reset many 2 3 times before the correct status on the iPAQ was activated Trial 3 Monitoring of vital parameters in patients with respiratory insufficiency During 20 9 and 21 9 they tried to activate start iPAQ for one hour each day but did not succeed to reach MBU sending status Had to reset iPAC 5 6 times each day and was not able to find in the user manual what was wrong On 21 9 the professional concluded that the Back End system might not be up and running At times the iPAQ could not be turned off Success rate 10 number of resets on iPAQ and GPRS sleeve Only approximately one out of ten resets of the system resulted in making the iPAQ active so you could fill in the manual data Trial 4 Home care and remote consultation for recently released patients in a rural area 16 44 There was start up failure The iPAQ had to be rebooted 7 out of 10 times There were also no problems encountered in activating the iPAQ Th
41. t for the start up to be easier and to proceed more automatically than in the current version GPRS connection stability This was considered to be a very important issue At this stage of the prototype the connection tends to be difficult to achieve and breaks off unexpectedly System providers indicate that this has been dealt with at time of publication and will feature in Version 3 1 With regard to length of time connected there is an interesting fact to note in Swedish Trial 2 Physical activity and impediments to activity in women with Rheumatoid Arthritis in the 8 September test the data was sent for a full 50 minutes to the Back End system As connection time in the other pre trials tended to be between two and seven minutes it would be very interesting for the system providers to investigate what particular factors caused this apparently ideal condition Batteries battery capacity is a bottleneck for many of the trials In Barcelona particularly the dependence on battery life was deemed to be crucial to the Outdoor training trial Mobility this is related to the battery with test users being dependent on being close to a power source as the batteries tend to drain quickly Wearability users generally state that carrying the iPAQ and Mobi is easy and not too intrusive and it is light and unrestrictive an exception was Barcelona Visibility of errors on iPAQ partners requested that there be some kind of sig
42. t the communication to fail more than it has been said The iPAQ has to be almost connected most of the time The mobility is then reduced This causes some strong difficulties to arise for the outdoors training trial The Netherlands Trial 1 Tele Trauma Team There was no pre trial in this area Trial 2 Integrated home care for women with high risk pregnancies The BAN does not restrict the mobility of the patients The wires are too long Because of the communication problems we were not able to test until now the sending of data when the patient is moving around They mostly tested the sending of data when they were at home 38 44 Part Four Other Comments Germany Trial 1 Secondary prevention in coronary heart disease The application and the system is yet not stable and user friendly enough to perform trials with patients who do not have much experience with new technology and a lot of patience in our trial site only two patients have the ability to use the BAN Right now we are dealing with a prototype version To run the trial these problems have to be solved in an upgraded version the connectivity to GPRS must be more stable IPAQ GPRS sleeve problem the communication between the IPAQ and the BE system must be more reliable application problem and the configuration must be more user friendly Sweden Trial 1 The Lighthouse alarm and locator Map with a dot indicating t
43. tivity in women with Rheumatoid Arthritis To get full mobility in this pre trial the critical factor is the battery consumption in the iPAQ Participants may wish to be outdoors for many hours Trial 3 Monitoring of vital parameters in patients with respiratory insufficiency The pulse oximetry sensor prevented the test person from performing activities that he wanted to do for example when cooking he almost cut the sensor cable off He felt that there were a large number of cables everywhere He also felt that it was hard to get the iPAQ to work He felt that he was aware all the time that he carried the BAN and particulary the pulse oximetry sensor He wore the BAN for a total of 8 hours during 20 22 9 divided into 2 4 2 hours In the overnight continuous trial the test user found it easy to move around and perform tasks with the full BAN on his body Trial 4 Home care and remote consultation for recently released patients in a rural area The BAN can be used as a mobility test in the home and in a car because of its size and easiness of use Spain Trial 1 Support of home based healthcare services 37 44 The battery of the device must be full or almost if we do not want the communication to fail more than it has been said The iPAQ has to be almost connected most of the time The mobility is then reduced Trial 2 Outdoor patients rehabilitation The battery of the device must be full or almost if we don t wan
44. ty of remotely supervised outdoors training programs based on control of walking speed enabled by use of the BAN The physiotherapist will receive on line information on 4 44 patient s exercise performance and will provide feedback and advice In this pre trial exclusively technical and medical personnel tested the system and the test was run in the hospital and between the hospital and the telecommunications service partner The Netherlands Trial 1 Tele Trauma Team This trial is for a sensor visual and transmission system for trauma medical care delivered by an ambulance at the scene or on the way to the hospital The main objectives are to examine the feasibility and safety of monitoring various vital signs recording the site of the accident and communicating with and guiding the paramedics all by sensors put by a paramedic upon the patient or worn by himself and relaying these data to the trauma hospital There was no pre trial on this occasion Trial 2 Integrated home care for women with high risk pregnancies The purpose of this study is to evaluate whether monitoring at a distance of vital signs e g CTG maternal blood pressure is feasible safe and can postpone hospitalization for women with a high risk pregnancy This pre trial monitored ten healthy pregnant women at a hospital and two at home 5 44 Part One Field Pre Trial Details per Site Testing period Germany Trial 1 Secondary prevention in coronary
45. user level has not been implemented yet Spain Trial 1 Support of home based healthcare services Due to the problems in terms of connections failing the system is not considered safe enough for real clinical cases Trial 2 Outdoor patients rehabilitation Same as section for Spain Trial 1 immediately above 35 44 The Netherlands Trial 1 Tele Trauma Team There was no pre trial in this area Trial 2 Integrated home care for women with high risk pregnancies No problem in this stage Because of the experimental character we only use healthy pregnant women They cannot answer the safety question I think that until the end of the MobiHealth period we only use healthy pregnant women Because of the communications breakdown the system as a whole is not safe Only when the system is safe can we answer the question of the feeling of safety of the pregnant women 36 44 Mobility Germany Trial 1 Secondary prevention in coronary heart disease It seems that data is not transmitted when IPAQ is more than 5 metres away No outdoor measurements were performed The BAN for itself does not restrict mobility Sweden Trial 1 The Lighthouse alarm and locator The trial owner could move around while wearing the BAN However there might be distance issues with moving far from a power source such as the MBU as the battery did not last for long on the MBU Trial 2 Physical activity and impediments to ac
46. want the communication to fail more than it has been said The IPAQ has to be almost connected most of the time The mobility is then reduced Trial 2 Outdoor patients rehabilitation Same as section for Spain Trial 1 immediately above The Netherlands Trial 1 Tele Trauma Team There was no pre trial at this stage Trial 2 Integrated home care for women with high risk pregnancies 19 44 There was a lot of trouble in sending the data Until now the problem s is are still not solved We are working on it together with Aart van Halteren of University of Twente This problem has lasted until now The iPAQ is brought to the University they fix it there is another try and the problem comes back every time The heart of the problem is the communication between the BAN and the iPAQ At this moment the situation is as far as a few weeks ago 20 44 Mobi iPAQ Back End system communication Germany Trial 1 Secondary prevention in coronary heart disease There were difficulties in getting connection between the Mobi and iPAQ Communication between the Mobi and iPAQ shut down after approximately four minutes in the best case In the connection between the iPAQ and the Back End system about 50 of data were never seen again Sweden Trial 1 The Lighthouse alarm and locator Mobi turned off spontaneously several times during the test The test person had to check if the Mobi was on all the time During the start up procedur
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