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Table of Contents
                            Seppälä_Paper I.pdf
	Chapter 8: Collaborative Approach for Sustainable Citizen-Centered Health Care
		8.1 Introduction
		8.2 Citizen-Centered Health Care Paradigm
		8.3 Examples of Citizen-Centered Care
			8.3.1 Personal Health Record
			8.3.2 Current Domains for Citizen-Centered Care
			8.3.3 Citizen-Centered Care from the Health Care Service Provider’s Viewpoint
		8.4 The Drivers, Barriers and Issues to Consider in Sustainable Citizen-Centered Care
			8.4.1 Drivers for the CCC-Model
			8.4.2 Barriers for the CCC-Model
			8.4.3 New Approaches to Consider
		8.5 Summary and Conclusions
		Reference s
Document Text Contents
Page 1


Context-aware and Trust-based
Personal Wellness Information Framework

for Pervasive Health

To be presented, with the permission of

the Board of the School of Information Sciences of the University of Tampere,
for public discussion in the Lecture Room Linna K 103,

Kalevantie 5, Tampere,
on April 16th, 2014, at 12 o’clock.


Page 2


Context-aware and Trust-based
Personal Wellness Information Framework

for Pervasive Health

Acta Universi tati s Tamperensi s 1924
Tampere Universi ty Pres s

Tampere 2014

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1178 Collaborative Approach for Sustainable Citizen-Centered Health Care

own data bases (Aaltonen et al. 2009 ; Iliakovidis et al. 2005 ; Basch 2005 ) . There are
also commercial products already available for citizens, e.g. Health Vault and
Google Health, that offer citizens tools to integrate their own health data with other
wellness information for their individual needs. These examples demonstrate the
ongoing shift from an organization-centered health care to citizen-centered health
care where the focus is on prevention, proactive services, healthy lifestyle and per-
sonalized services for citizens.

8.2 Citizen-Centered Health Care Paradigm

Current health care systems are organization-centered and patient care processes
are static and designed mostly from the physicians’ viewpoint. Patient care is
focusing on treatment of diseases and care is organized by specialty or interven-
tion. Care is composed of sequences of care episodes given by various providers
and this situation does not really support multi-professional and collaborative care.
There is lack of communication between the participants and also many delays and
queues in the processes (Teperi et al. 2009 ; Koop et al. 2008 ; Pratt et al. 2006 ;
Ohashi et al. 2010 ) .

In the citizen-centered care (CCC) paradigm health care systems should trans-
form their processes in such a way that the individual citizen is placed in the middle
of health care processes. Health is seen in a more holistic way where the focus is on
individual’s complete wellness, covering health, diseases, care, prevention, well-
ness and healthy lifestyle. Essential is that citizen-centered care will enable the
citizen to take an active part in his/her health care processes throughout his/her
lifetime anytime and anywhere (Teperi et al. 2009 ; Wartena et al. 2009 ; Pratt et al.
2006 ; Ohashi et al. 2010 ; Nykänen 2008 ; Tang and Lansky 2005 ) .

The core of the citizen-centered care paradigm is to focus on preventive care, on
proactive services, on early detection and diagnosis to ensure citizens personal
wellness. Thus, there is a need for new citizen-oriented services covering health
promotion, health maintenance and citizen education and empowerment Also health
care providers should be open and able to communicate and give citizens more
information on their health and wellness related issues (PricewaterhouseCoopers
Health Research Institute 2005 ; Wartena et al. 2009 ; Koop et al. 2008 ; Ohashi et al.
2010 ; Continua Health Alliance 2005 ; Kolitsi and Cabrera 2007 ; Berry and
Mirabito 2010 ) .

Citizen-centered care creates a need for new kinds of interoperable and sharable
networks of services which can also include other actors than health care providers.
These networked services create new challenges for health care systems and care
processes should become multi-professional, decentralized, distributed, easily
accessible and based on personalization of care. When patient care is shared in the
network of service providers there is a need to share also the patient data and care

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118 P. Nykänen and A. Seppälä

management. Currently patient data is fragmented and stored in distributed data
bases and it is not easily accessible when and where needed (Varshney 2007 ; Pratt
et al. 2006 ) . Shared care processes need interoperable information systems to han-
dle increasing number of information sources and participants in the patient care
(Koop et al. 2008 ; Ohashi et al. 2010 ) .

Since citizen-centered care model is based on the networked services and shared
care management there is a need for extended communication and co-operation
through processes to ensure comprehensive services. Different participants in care
processes need real-time reliable information to be able to make justifi ed decisions.
The amount of health related information is increasingly growing and it is critical to
have access to citizens’ histories, medications, test results and clinical records but
also to their lifestyle choices, behaviors and personal information (Tang and Lansky
2005 ; Kolitsi and and Cabrera 2007 ) . A requirement for implementation of the citi-
zen-centered care model is empowerment of the citizens. Citizens are not anymore
passive users of services but active participants in the care processes who take
responsibility of their care (Pratt et al. 2006 ; Kolitsi and Cabrera 2007 ) .

Current health care services are fragmented and therefore the citizens now need to
act themselves as care integrators who are responsible for the completeness of care
(Monteagudo and Moreno 2007 ; Pratt et al. 2006 ) .Citizen empowerment is seen as a
potential tool to cut down costs in health care, because much of the responsibility is
moved to the citizen (Monteagudo and Moreno 2007 ; PricewaterhouseCoopers
Health Research Institute 2005 ; Wartena et al. 2009 ) and maintenance of wellness
and prevention has better return of investment than treatment of a disease after diag-
nosis (Continua Health Alliance 2005 ; Berry and Mirabito 2010 ; World Health
Organization (WHO) 2006 ) .

Increased empowerment of citizens and their collaboration with service providers
may improve the quality of care through improved lifestyle choices and health
behaviors, better disease management, improved care coordination, and following
better care recommendations. High quality information is needed to empower the
citizens to make effective decisions and choices. Missing information can be dam-
aging to citizens, their relatives and proxies and also to health care providers
(Monteagudo and Moreno 2007 ; Varshney 2007 ; Center for Information Technology
Leadership (CITL) 2008 ) .

In citizen-centered care model citizens should be able to access health care from
and at their homes and in everyday life, instead of visiting health care organizations.
Technology makes it today possible to support the citizens’ activities outside the
care provider networks. These activities vary from life style and self health manage-
ment to improving the life of citizens as well as managing chronic diseases (Continua
Health Alliance 2005 ; Kolitsi and Cabrera 2007 ) . For example chronic diseases
related to the lifestyle are one of the main reasons for diseases and deaths in the
developed countries (World Health Organization (WHO) 2006 ; Mattila et al. 2010 ) .
It would be very benefi cial and cost-effective to help citizens to better manage their
chronic diseases and possibly prevent these diseases by offering citizens informa-
tion and support for prevention and healthy lifestyle.

Page 165

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IT: information technology
PHS: personal health system

Edited by G Eysenbach; submitted 21.11.13; peer-reviewed by S Koch, J Zvarova, S Mohammed; comments to author 16.12.13;
revised version received 26.01.14; accepted 12.02.14; published 11.03.14

Please cite as:
Sepp�l� A, Nyk�nen P, Ruotsalainen P
Privacy-Related Context Information for Ubiquitous Health
JMIR Mhealth Uhealth 2014;2(1):e12

©Antto Seppälä, Pirkko Nykänen, Pekka Ruotsalainen. Originally published in JMIR Mhealth & Uhealth (,
11.03.2014. This is an open-access article distributed under the terms of the Creative Commons Attribution License
(, which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The complete bibliographic information,
a link to the original publication on, as well as this copyright and license information must be included.

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