mICF project plan accepted at FRDG midyear meeting in London (May 2014)

Developing a mobile application for the International Classification

for Functioning, Disability and Health

An international collaborative of the Functioning and

Disability Reference Group of the World Health

Organisation’s Family of International Classifications

(WHO-FIC)

mICF: Project Scope & Project Plan Update: 10 June 2014

Complied by:

Stefanus Snyman, Werner Mostert, Vincenzo Della Mea, Olaf Kraus de Camargo

with the contributions from other FDRG partners.

mICF: Project Scope & Project Plan (5 May 1014)

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1 BACKGROUND

Increasingly mobile phone applications are used to collect and provide health information and facil itate

decision making. Currently, no mobile applications incorporate the International Classification of Functioning,

Disability and Health (ICF), except for emerging prototypes l ike the ICanFunction Application destined to be

used with children and youth (Kraus de Camargo, 2013; Kraus de Camargo, 2012). The ICF is a framework

developed by the WHO, documenting information on functioning as dynamic interaction between a patient's

health condition, environmental factors and personal factors, facilitating decision-making and continuity of

care. ICF highlights the need for a diverse team of service providers, but also represents a paradigm shift in

how to approach health and healthcare (see figure 1).

Figure 1. The ICF framework adapted from WHO (2001)

Dubbed the mICF, the aims of this project are to build an international collaborative of ICF specialists, as well

as experts in health informatics and information technology to investigate the development of a user-friendly

mobile application to

1) assist providers and users of health services in the front l ine (e.g. patients, parents, health service

providers, teachers) to identify a person's problems in terms of the ICF (functional status and

contextual information), and

2) to amalgamate ICF-related data centrally.


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It is envisaged that the mICF will

1) ensure accurate and efficient capture of functional status and contextual information,

2) convey information securely between service providers in different service settings,

3) facil itate clinical decision-making by making person-centred data readily available,

4) facil itate administration and reporting through the aggregation of the data and

5) minimise the need for repeat data collection.

At the annual meeting of the Functioning and Disability Reference Group (FDRG) of the World Health

Organisation’s Family of International Classifications (WHO -FIC) in 2013, it was agreed to encourage the

development of a collaborative to investigate the development of a mobile application for the ICF. Currently

40 collaborators form 17 countries indicated their interest to collaborate in developing the mICF. Anyone

interested in joining the collaborative is encouraged to complete an online questionnaire at

http://tiny.cc/icfmobile .

During the first year of this three-year project, the requirements for the mICF will be determined by

conducting a survey, l iterature review and two workshops. In the second year the prototype will be developed

and field tested, before the end product is launched in 2016. Thereafter the efficacy of mICF will be evaluated

regarding the improvement of patient-centred health outcomes, communication across continuum of care,

patient satisfaction and cost effectiveness of service delivery.

The envisaged benefits of the mICF would be to:

1. Empower providers and users of health and related services

2. Facilitate universal healthcare

3. Enable continuity of care

4. Capture the interactions between ICF components to facil itate

5. Understanding of the complexity of interactions between health and contextual factors

6. Patient-centred decision-making and goal setting

7. Interprofessional and transprofessional collaborati ve practice

8. Amalgamate data to help strengthen systems .

2 AIMS, OBJECTIVES AND ACTION STEPS

Figure 2: Visualisation of the mICF Project

http://tiny.cc/icfmobile


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The aims of this Collaboration are to investigate the development of a user-friendly mobile application to

1) assist providers and users of services in the front l ine (e.g. patients, parents, health service providers,

teachers) to identify a person's problems in terms of the ICF (functional status and contextual

information), (see 2.1) and

2) to amalgamate ICF-related data centrally (see 0).

Table 1: Summary of the aims and objectives

AI MS OBJECTI VES AND ACTI VI TI ES

1. Ass ist providers and users of services in the front line (e.g. patients, parents, health service providers, teachers) to identify a person's problems in terms of the ICF (functional status and contextual information),

1. Develop the specifications for the mICF to enable programmers to develop the application.

Activi ties

Needs requirement survey Li terature review

2 Workshops 2. Provide a means for providers and users of health services to collect and

transfer ICF-related information to facilitate the continuity of care

Activi ties

Developing a mICF

Testing the prototype Refine the prototype and develop the final product

Test the final product as well as usefulness of algorithms.

2. To investigate the development of a user-friendly mobile application to amalgamate ICF-

related data centrally

1. Convey information securely between service

2. Ensure a sustainable and cost-effective platform 3. Faci litate administration and reporting

4. Providing person-centred feedback to inform shared decision-making

The first aim focuses on ensuring accurate and effi cient capture of functional status and contextual

information to facil itate person-centred decision making and continuity of care, whereas the second aim is to

ensure reporting for administrative and research purposes.

2 .1 AI M 1 (2014 -2015)

Aim 1: To investigate the development of a user-friendly mobile application to assist providers and users of

health services in the front l ine (e.g. patients, healthcare providers) to identify a person's problems in terms of

the ICF (functional status and contextual information)

The first aim will be reached by the following objectives between May 2014 and February 2015:

2 .1 .1 OBJECTI VE 1 :

The first objective is to develop the specifications for the mICF to enable programmers to develop the

application. It includes the following activities:

1) Needs requirement survey for the mICF will be conducted among

a) Service providers (e.g. community care workers, community rehabilitation workers, primary

health care nurses; teachers, social workers, other health professionals), users of health

services (e.g. patients, parents), and

b) Administrators (e.g. academics, statisticians). This will be conducted by the collaborators in

their countries (Results available: September 2014). The survey will be available online in

various languages.


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ACTION STEPS BY WHO (Lead: Olaf Kraus de Camargo) BY WHEN

Finalise English Questionnaire & write cover letter

Stefanus Snyman; Olaf Kraus de Camargo; Catherine Sykes

2014-06-10

Final draft back from comment 17 June (feedback received) 2014-06-17

Launch English survey online Stefanus Snyman; Olaf Kraus de Camargo; Catherine Sykes

2014-06-20

Translate to different languages Luis Salvador-Carulla: Spanish

Marie Cuenot: French

Vincenzo Della Mea: Italian

Olaf Kraus De Camargo: German &

Portuguese Haejung Lee: Korean

Jaana Paltamaa: Finnish

Stefanus Snyman: Afrikaans

Sirinart Tongsiri: Thai

Coen Van Gool: Dutch

2014-07-07

Launch survey in other languages Stefanus Snyman; Olaf Kraus de Camargo and language representatives

2014-07-15

Submit abstract for WHO-FIC Olaf Kraus de Camargo; Stefanus Snyman

2014-07-15

Survey closes Olaf Kraus de Camargo 2014-08-29

Analysis data completed Olaf Kraus de Margo; Stefanus Snyman 2014-09-03

Submit poster for Barcelona Olaf Kraus de Margo; Stefanus Snyman 2014-09-05

Submit report for mICF workshop Olaf Kraus de Margo 2014-10-09

2) Literature review to determine the characteristics of a successful mHealth applications for front l ine

service providers (Results available: September 2013).

Four components of the literature review has been suggested:

a) Relevant ICF articles and documentation of how ICF is used (especially by front l ine service providers)

b) Current ICF electronic systems and other related ICT systems (e.g. tabling strengths and limitations of

each tool: FABER, eFROHM, iCAN, BigMove, ICF machine, Revalidatie EPD, St Louis Uni

(http://www.slu.edu/nl-rel-comm-sci-dod-grant-829)).

c) Characteristics of effective mHealth applications that enable decision-making on service level (also

l iaising with mHealth Alliance)

d) Building on the needs requirement survey (see above) a review will be done of how CCWs, CBR

workers and other front l ine service providers effectively use mobile applications (e.g. l inking with

experience from South Africa, Sierra Leone, Handicap International )

A report of the literature review will be drafted for the Barcelona meeting. This report together with the

results of needs requirement survey will form the basis for determining the specifications of the mICF. A

peer-reviewed article will be the results of this first phase of the project.

http://www.slu.edu/nl-rel-comm-sci-dod-grant-829


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All the articles, websites, documents or multimedia identified during the literature review will be placed in

a Research Repository (click here) which will be available to collaborators and researchers. This can tie in

with other FDRG literature activities.

ACTION STEPS BY WHO (Lead: Patricia Saleeby) BY WHEN

Create Dropbox for references Stefanus Snyman 2014-05-05

Determine scope of mICF literature study Patricia Saleeby (convenor), Jaana Paltamaa, Coen van Gool, Vincenzo Della Mea, Olaf Kraus de Camargo, Stefanus

Snyman (?& mHealth Alliance)

2014-05-31

Finalise l iterature review team Patricia Saleeby 2014-05-31

Write protocol for article (Literature review and survey)

Coen van Gool 2014-06-30

Submit abstract for Barcelona meeting Patricia Saleeby & Stefanus Snyman 2014-07-15

Complete l iterature review Patricia Saleeby (convenor) 2014-08-31

Submit poster for Barcelona Patricia Saleeby (convenor) 2014-09-05

Present findings at Barcelona meetings Patricia Saleeby (convenor) 2014-10-09

Finish article Review team 2014-11-30

3) Workshop 1 between the Collaborators to define the specifications for the mICF as informed by the

survey and literature review (9-10 October 2014, Barcelona, Spain)

ACTION STEPS BY WHO (Lead: Stefanus Snyman) BY WHEN

Secure free venue in Barcelona 2 days prior to start of WHO-FIC meetings

Stefanus Snyman 2014-05-31

Determine agenda Stefanus Snyman & Vincenzo Della Mea 2014-06-10

Send invitations to mICF partners Stefanus Snyman 2014-06-10

Find logistics organiser for meeting in Spain Stefanus Snyman 2014-06-10

4) The Collaborators involved in Workshop 1 will report back to the Annual World Health WHO-FIC Meeting

(10-17 October 2014, Barcelona, Spain) to gain further support and to l iaise with other interested

international collaborators.


Report on needs requirement survey (and poster)

Olaf Kraus de Camargo 2014-10-09

mICF Literature review report (and poster) Patricia Saleeby 2014-10-09

Updated project plan and specifications Stefanus Snyman 2014-10-11

Funding proposal Stefanus Snyman 2014-10-09

https://www.dropbox.com/sh/wh9yvlunmkjklf7/AABEJwPyf2vweuKl6wNQ08jCa


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5) During Workshop 2 IT specialists will finalise the specifications for the (1) mICF mobile application, (2)

mICF database, and (3) mICF web platform for institutional and government users. The workshop will be

hosted by Stellenbosch University, South Africa. (Proposed dates: 19 – 24 January 2015).


Secure venue Stefanus Snyman & Cornie Scheffler 2014-07-15

2 .1 .1 .1 EXPECTED OUTPUTS I N REACHI NG THI S OBJECTI VE:

1) An article on the findings of literature review and survey will be published in a peer-reviewed

journal. The uniqueness of the needs requirement survey and literature review is not only in terms of

the ICF, but also in the design and interface of a user-friendly mobile application to inform decision

making.

2) Report to inform an evidence-based benchmark for the specifications of the mICF.

3) A repository (adding to current FDRG initiatives) of articles, websites, documents, multimedia, etc.,

identified during the literature review.

4) Presenting of research findings at conferences.

5) Final project plan and specifications that IT experts can use to develop a mICF prototype.

6) Other international partners committing to contribute to the development of the mICF.

7) Detailed workshop agenda for IT workshop in January 2015 in Stellenbosch, South Africa.

8) Grant applications and funding

2.1 .2 OBJECTI VE 2 :

The second objective is to provide a means for providers and users of health services to collect and transfer

ICF-related information to facil itate the continuity of care (March 2015 - February 2016). This objective will be

reached by the following activities:

1) Developing a mICF prototype mobile application on an Android platform

2) Testing the prototype on frontline users (both service users & service providers) to evaluate usability

and user acceptance of the mICF.

3) Refine the prototype and develop the final product

4) Test the final product as well as usefulness of algorithms.


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2 .2 AI M 2 (2016)

Aim 2: To investigate the development of a user-friendly mobile application to amalgamate ICF-related data

centrally (March 2016 - December 2016).

The “amalgamation process” is the key issue to the success of the mICF. It is therefore important for a

technical team to specify it in detail at the Barcelona meeting.

ACTION STEPS BY WHO (Lead: Coen van Gool) BY WHEN

Ensure relevant technical / big data experts attend workshops in Barcelona and Stellenbosch (e.g. Carolyn McGregor)

Coen van Gool, Vincenzo della Mea, Cornie Scheffler, Olaf Kraus de Camargo

2014-07-31

Compile specifications documentation after

Barcelona workshop

Technical team 2014-10-31

2 .2 .1 OBJECTI VE 1

The first objective in reaching this aim is to be able to convey information securely between service

providers in different service settings consistent with ethical and privacy principles in relation to data

sharing, e.g. among clinicians.

Activity: Survey current security standards as applied in communication between healthcare

information systems (e.g., by analysing HL7 and IHE integration profiles), with the specific mICF

application in minf. Survey should also be made in relation with local regulation on privacy and ethics

to investigate compliance, so a preliminary survey on relevant on all the collaborators laws will be

carried out.


The second objective, to ensure a sustainable and cost-effective platform minimising the need for

repeat data collection, will be reached by analysing available health information systems of the

Collaborators.

Activity: In order to minimise data replication and thus reduce the so-called "data silos" effect, an

analysis of available health information systems in all the Collaborating countries will be carried out,

aimed at identifying i) possible sources of needed data that are already been collected in some other

systems (e.g., clinical records) and ii) possible destinations of data collected by mICF (e.g., disability

certification systems). Once identified, a proposal regarding interoperability could be carried out,

letting its implementation to some further specific project.


The third objective is to facil itate administration and reporting through data aggregation and data

analysis.

Activity: Health data visualization is a crucial issue, and ICF does not make things easier. ICF data

constitute a rich person profile that may partially change in time, in particular when the subject is

involved in some process, l ike care, rehabilitation, school, etc. Starting from expert panel opinions on

the needs, a dashboard of tools for aggregating and visualizing ICF profiles will be provided on the

server hosted part of the application. This will be designed having in mind a web-based system with

responsive pages, in order to be viewable on computers as well as mobile devices of any kind.


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The fourth objective is to empower service providers and users by providing person-centred feedback

to inform shared decision-making through the development of a recommender system based on

analytic algorithms of the database with different functional profiles.

Activity: As a last activity, a visionary exploration aimed at decision support tools will be started, to

identify possible rules that l ink together data coming from ICF profiles and possibly from other

information systems, in order to inform caregivers in their daily activity. In particular, already

collected data might be used to suggest further observations to be made, when some gap is identified

or when some available ICF qualifier seems to suggest further investigations in a specific direction. As

a possible example, issues evidential on the Activities and Participation component might trigger

inquiries on Functions and Body Structures that could be relevant for the specific activities. In order to

carry out the task in the best possible way, a set of available ICF profiles would help. These may come

from previous research activities of the partners, or be collected during the present project. Either

way, an analysis of such data using some data mining tool or some classification tool l ike Weka might

help to recognize candidate rules.

3 TIMELINE

Figure 1. Proposed timeline for total project

Table 1. The proposed activities for 2014/15

Activity Period Venue Leads

Stefanus Snyman

Needs requirement survey May-Sept 2014 Collaborating

countries

Olaf Kraus de Camargo

Literature review May-Sept 2014 Virtual Patricia Saleeby

Workshop 1 9-10 Oct 2014 Barcelona, Spain Stefanus Snyman & Vincenzo

Della Mea

Feedback WHO-FIC 11-17 Oct 2014 Barcelona, Spain Stefanus Snyman

Workshop 2 19-24 January 2015). Stellenbosch, South

Africa

Stefanus Snyman

2014

•Determine the requirements for the mICF (technical and subject specific)

2015

•Developed prototype and field tests

2016

•Launch of the end product


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4 RESOURCES

4.1 RESOURCES AVAI LABLE

4 .1 .1 CURRENT COLLABORATORS

Collaborators can sign up by completing the survey: http://tiny.cc/icfmobile

Surname First Name Country

1. Anderson Jake Switzerland

2. Anttila Heidi Finland

3. Bhattal Navreet Australia

4. Carvell Karen Canada

5. Celik Can Switzerland

6. Cho Dae Bong Korea

7. Cuenot Marie France

8. Della Mea Vincenzo Italy

9. Dewan Neha Canada

10. Ferreira Luana Brazil

11. Frattura Lucil la Italy

12. Goliath Charlyn South Africa

13. Hanmer Lyn South Africa

14. Iten Nicole Canada

15. Jelsma Jennifer South Africa

16. Jindal Pranay Canada

17. Khalil i Hossein Canada

18. Kraus De Camargo Olaf Canada

19. Lee Haejung Korea

20. Leonardi Matilde Italy

21. Lopes Sónia Portugal

22. Madden Ros Australia

23. Maribo Thomas Denmark

24. Martins Anabela Portugal

25. Martinuzzi Andrea Italy

26. Miller Janice Canada

27. Mostert Werner South Africa

28. Paltamaa Jaana Finland

29. Pretis Manfred Austria

30. Salvador-Carulla Luis Australia

31. Scheffer Cornie South Africa

32. Simoncello Andrea Italy

33. Snyman Stefanus South Africa

34. Suvapan Daranee Thailand

35. Sykes Catherine UK

36. Tongsiri Sirinart Thailand

37. Valerius Joanne USA

http://tiny.cc/icfmobile


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38. Van Gool Coen Netherlands

39. Vuattolo Omar Italy

40. Wöbke Nils Germany

4 .1 .2 COUNTRY REPRESENTATI ON OF CO LLABORATORS

1. Australia 3

2. Austria 1 3. Brazil 1 4. Canada 7 5. Denmark 1

6. Finland 2 7. France 1 8. Germany 1

9. Italy 6 10. Korea 2 11. Netherlands 1 12. Portugal 2

13. South Africa 6 14. Switzerland 2 15. Thailand 2

16. United Kingdom 1 17. United States 1

4 .1 .3 EQUI PMENT AVAI LABLE:

a) Computing equipment: web server of the Medical Informatics, Telemedicine and eHealth Lab

with Cpu Intel Core i7 3770 3,4 Ghz Ivy Bridge LGA1155 16 GB DDR-3 1600 MHZ and 2 HD 2 TB

SEAGATE, with Ubuntu Linux OS (usage: 10%).

b) Computing equipment: mobile devices of the Context-Aware Mobile Systems Lab, including

Android devices, iPhone, iPad (usage: 20%).

c) Rooms for meetings foreseen in the project.

4 .1 .4 FI NANCI AL RESOURCES AVAI LABLE

Currently no funds is available.

4 .2 RESOURCES NEEDED AND GRANT APPLI CATI O NS

ACTION STEPS BY WHO (Lead: Coen van Gool)

BY WHEN

Budget to be determined in Barcelona Stefanus Snyman 2014-10-11

Compile grant proposal writing team and work out plan of action

Stefanus Snyman 2014-07-31

5 MODE OF COLLABORATION

Most collaborators are known to each other through the work of the FDRG and other WHO -FIC committees..

Our proposed mode of co-operation is regular Skype conferences, working on a shared Google drive and

meeting annually at the WHO-FIC meetings for a week.

The nature of the collaboration will be a consensus -based partnership embracing trust and mutual respect.


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During the next three years a series of workshops will be hosted to work through the various activities as

envisaged in the proposed plan. The current collaborators have the following expertise between themselves:

1) Developing the ICF, ICF-CY and specific core sets.

2) Contributing in the developing an ICF ontology.

3) Collecting and analysing ICF related data.

4) Using of the ICF in clinical decision making and goal setting (health, social work and education)

5) Engaging with community care and community rehabilitation workers, as well as other service providers

on the front l ine of service delivery, with a focus on continuity of care.

6) Developing electronic appl ications for the ICF, e.g. the ICF Machine, FABER, eFROHM and the

conceptualisation of the iCAN mobile application. These initiatives will inform the development of the

mICF.

7) Researching the application of ICF in various settings

8) Developing eHealth and mHealth applications for primary healthcare workers

9) Writing grant proposals

10) Project management

6 SOCIAL BENEFITS

The mICF will provide a means to collect and transfer ICF related information. This will allow for better

dissemination of information to users and providers of services in all settings. Service users will have improved

access to health information and services. It will further improve disability surveillance, collection of disability

related data and management of user records, thereby improving quality and continuity of care and assisting

in preventing disability and promoting health. The mICF will enable remote treatment and monitoring by

allowing to shift the focus of treatment from hospital and community care setting to home settings thereby

reducing costs of hospitalisation and providing access to health care resources remotely. It thus can be argued

that the mICF can empower patients with information and motivation to improve lifestyle and reduce the

threat of chronic diseases that could lead to disability. The mICF could be used as a tool to assist with patient

education, awareness and behavioural changes. Information could be accessed on mobile devices assisting

patients in making informed choices for improved health. It could also be used as a tool to motivate patients.

This application could be used as a means for peer support amongst pa tients. The mICF could also add value to

interprofessional collaborative practice and training of health care workers. Health care workers will have

immediate access to information about patients but also access to information that will assist evidence based

informed decision making. It will be able to provide education material to healthcare workers in remote areas

to ensure easy access to up-to-date information

7 REFERENCES

Bhattal, N. 2010. Evaluation of back-end usability of an electronic data capture tool on functioning, disability

and health. Sydney: University of Sydney.

Braun R, Catalani C, Wimbush J & Israelski D. 2013. Community health workers and mobile technology: a

systematic review of the literature. PLoS One, 8(6):e65772.

Della Mea V & Fioresi V. 2012. ICF machine: a web-based system for collection of ICF data . Stud Health Technol

Inform, 180:1188-90.

Dufour SP & Lucy SD. 2010. Situating Primary Heal thcare within the International Classification of Functioning,

Disability and Health: Enabling the Canadian Family Health Team Initiative. Journal of

Interprofessional Care, 24(6), 666-677.


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Fiordelli M, Diviani N & Schulz PJ. 2013. Mapping mHealth research: a decade of evolution. J Med Internet Res,

5(5):e95.

Frattura L, Simoncello A, Bassi G, Soranzio A, Terreni S & Sbroiavacca F. 2012. The FBE development project:

toward flexible electronic standards -based bio-psychosocial individual records . Stud Health Technol

Inform, 180:651-5.

Kraus de Camargo, O. 2012. ICanFunction - The ICF-App Development [online]. Available:

https://www.facebook.com/ICanFunction.

Kraus de Camargo, O., et al. 2013. The ICanFunction App - The International Classification of Functioni ng

Application, Demonstration Poster. 67th Annual Meeting of the American Academy of Cerebral Palsy

and Developmental Medicine. Milwaukee, WI, AACPDM.

Rajput ZA, Mbugua S, Amadi D, Chepngeno V, Saleem JJ, Anokwa Y, Hartung C, et al. 2012. Evaluation of an

Android-based mHealth system for population surveillance in developing countries. J Am Med Inform

Assoc, 19(4):655-9.

WHO. 2011. mHealth: New horizons for health through mobile technologies [online]. Available:

http://www.who.int/goe/publications/ehealth_series_vol3/en.

WHO. 2013. How to use the ICF: A practical manual for using the International Classification of Functioning,

Disability and Health (ICF). Exposure draft for comment. October 2013. Geneva: World Health

Organisation.

World Health Organisation. 2002. Towards a Common Language for Functioning, Disability and Health: ICF .

Geneva: World Health Organisation.

World Health Organisation. 2001. International Classification of Functioning, Disability and Health. Geneva:

World Health Organisation.

mICF project plan accepted at FRDG midyear meeting in London (May 2014)

Mobile

Transcript of mICF project plan accepted at FRDG midyear meeting in London (May 2014)