**3. mHealth opportunities in patient monitoring**

In this study, electronic chronic disease management systems based on mobile technology were divided into two types: agent-based systems and nonagent-based systems. Some electronic health system based on agent that studied in this research are:


Also other nonagent and useful e-health system survey in this section are:


**•** In 2009, the first virtual diabetes clinic in Iran was inaugurated at Tehran University of Medical Sciences with common database, multiaccess server architecture, and organizer server is discussed in this chapter [43–45].

**3. mHealth opportunities in patient monitoring**

82 Mobile Health Technologies - Theories and Applications

electronic health system based on agent that studied in this research are:

nication between patient and health care providers [35, 36].

mobile base unit, back end [37, 38].

end are the architecture elements [37, 40–42].

Also other nonagent and useful e-health system survey in this section are:

In this study, electronic chronic disease management systems based on mobile technology were divided into two types: agent-based systems and nonagent-based systems. Some

**•** Integrated mobile information system (IMIS) in Sweden through mobile network commu‐ nication platform provides the possibility of self-treatment and home care supervision for the diabetic patient. This system has six databases: (1) database for patients including all necessary information about diabetic health care centers, medical journals, dietary, food habits, etc.; (2) database for care providers containing whole information about physicians, home care services; (3) tools or instrument base including all aiding functions for imple‐ mentation health care such as visit reserve, alarms, monitor; (4) community network include all relevant actors like diabetes centers, consultation, and so on links to each other; (5) database for laws, rules, and norms applied in health care including all legal and cultural documents about health care therefore can help with privacy, security, and quality of services; and (6) database for labor division in health care that determines who (health care provider) and what to do, this ensures to provide all the different patient needs [31–34].

**•** M2DM Telemedicine Service system in European Commission with the aim of presenting correct knowledge to correct people at correct time. Two types of agents are used in the M2DM: (1) communication server that is responsible for communication between different user terminals and (2) application server that is responsible for data analysis and processing. The architecture of this system includes multiaccess server, common database management system (DBMS), multiaccess organizer, communication server agent, and application server agent. The overall goal of M2DM is increasing quality of care through improving commu‐

**•** Personal Health Monitor (PHM), University of Sydney, Australia, uses PHM with focus on e-health services based on mobile devices at local level for monitoring patient in various situations therapeutic. Architecture of PHM comprises BAN devices, sensor front end,

**•** Mobi Health and Body Area Network [BAN], most of the European countries use this system for remote patient monitoring and provide appropriate care to patients. A consortium of 14 European countries was set up to implement the health system project [39]. This project has been implemented in four countries: Spain, the Netherlands, Sweden, and Germany for different groups of patients, including home care and trauma, where the patient is located in an outdoor center. It aims to improve patients' quality of life and freedom in their daily activities and complete mobility. BAN devices, sensor front end, mobile base unit, and back

Some benefits of nonagent-based system in **Table 1** include disease prevention improvement, better self-care, increased life style quality, reduce unnecessary [re]hospitalizations, possibility of teleconsultation, and provide patients mobility to perform their daily works. Diabetes virtual clinic is used for monitoring system and as a proper tool that provides up-to-date, useful, relevant, and accurate information used to suitable self-care and remote health care. Access of all users to useful and necessary information about prevention, treatment, side effects, and ways to control diabetes and providing teleconsultation are most important advantages of a virtual clinic.

In PHM, data processing is done locally, and in Mobi health BAN processing can be done at server side. Some of the studied system implemented on PDA and mobile phone platforms,


**Table 1.** Electronic health system characteristics in chronic disease management.

and others implemented on mobile phone. Sending alarm to patients and health care providers and identify place of patients with GPS are possible in some of the studied systems. Wired and wireless communication in all system studied can be useful especially when mobility is desired.

Recently, health care systems shift toward fast achieving to right decision to solve problems with spending least costs. So to reach this goal, find suitable information from useful and reliable resources in the fastest time and the least possible effort for information searching, analyzing, and filtering is very important.

This requires high interoperability among different professionals and systems in various places. In fact for providing effective health care and shared information, all actions need to be coordinated. Facilitated decision making requires interoperability and effective communi‐ cations between professionals. Finding standard software as a suitable solution for complex health challenges is not easy. Electronic health systems must be proactive in anticipating the health information needs and supporting communications.

Because of potential capabilities of agent technology like mobility [44], autonomy, interoper‐ ability, scalability and re-configurability, integrating disparate systems, improving distributed data and resources management, handling the complexity of solutions, modeling and organ‐ izing the interrelationships between components [31–36, 46–51], is very valuable tool for telemedicine and telecare.

Agent-based systems in this table increase quality of care management. For example in IMIS system, tasks were delegated and all users in each level can communicate with one another and share the relevant data. In M2DM system, various analytic ways through knowledge agent were combined and used for the identification of abnormal situations. Also sending alarms, analysis results and real-time feedbacks to users are some benefits of this system [31–36]. Agents can be implemented on portable and mobile devices like PDA and use web services to interact with other systems.

The IMIS platforM is based on the Internet and will be accessible by PC or wireless network PDA. Accessibility should be regulated by groups of users. Each step in this system by the user is followed with instant feedback. M2DM can be activated in three ways: based on user needs, with receiving data, and by system. This system uses inexpensive and widely accepted technologies. This system applies technologies such as WEB, WEB TV, and SMS that are supported with computers or mobile terminals. Also it combines innovative and advanced technologies like PDA, WAP, GPRS, and PALMTOPS. The use of such technologies is limited in small groups of users because of costs, accessibilities, and user skills required.

Overall, according to multiagent health systems advantages in comparison to other type of systems and challenges in health care systems especially in diabetics care management, it can be said that the use of agent technology as a new and modern technology to reach full advantages of telemedicine and telehealth is essential, and health systems in the world must move toward agent-based applications.
