MODIFICACIONES DEL METABOLISMO DE LA GLUCOSA EN EL EMBARAZO

The main issues of using social media in healthcare are privacy concerns [8] [79] [11]. Due to the sensitivity of health data and related legal regulations, the use of public OSN systems for private healthcare systems might appear to be infeasible. Accordingly, implementation and development in healthcare have been focusing on building private and closed systems which are expensive and cannot be used easily by people.

There is much evidence showing benefits in using online social media to reduce cost and improve quality of healthcare, e.g. providing social support and collaboration in

healthcare [15], supporting new ways of interaction and better communication [61] and improving the relationship between patients and healthcare providers [19] [141]. Studies show the increasing popularity of OSMPs extended to the healthcare domain [139] [19] [27] [140].

However, due to privacy concerns, the use of OSNs has been limited to specific aspects of healthcare, e.g. Patientslikeme [110] is a dedicated platform for patients to share ex- periences, health interests and concerns; Doximity [38], QuantiaMD [118], SharePractice [129], Figure1 [41] and Sermo [128] provide similar facilities for doctors to suppport and collaborate between healthcare professionals; and HelloHealth [65] is a private platform for maintaining Electronic Health Record (EHR) data. The use of an OSN enables better collaboration and communication for patients and healthcare professionals in a health- care network, as well as improving healthcare efficiency. These technologies re-focus the patient-physician relationship [16] to patient-centric while enabling better collaboration and communication between patients, caregivers and physicians.

In addition, social networking and online communities can help provide motivation. As a result, many existing health applications try to imitate the concept of an online so- cial network by creating a community feeling, i.e. sharing and competing with friends and family, having friends or groups and having forums for social communication. An example is a fitness application developed in [91] which has socialisation features for shar- ing, competing and collaborating with friends. Also, mobile applications like [112] build a health social network to send and receive health tips and encouragement as well as act- ing as an interface to accumulate health and fitness activities from various fitness device, e.g. Fitbit, into one interface. There has also been an increased interest in closed-loop healthcare which enables patients to receive feedback to improve their healthcare, e.g. ap- plications in [29] and [83] provide feedback of users’ current wellbeing states to promote awareness and improve health levels.

According to the report from the Pew Research Center [113], the use of social media continues to grow among all age groups of patients including an elderly. The study by Scanfeld et al [127] showed that people are willing to share their health-related informa- tion online, under certain conditions. This results in an increasing number of social net-

working communities targeted towards health and wellbeing. The work in [6] integrated social media such as Facebook, Twitter, and Youtube with healthcare information systems, as an input for decision support. Similarly, the study in [95] employed social network technologies for decision making to encourage colloboration among health professionals.

The investigation by Norval et al [106] suggested the use of an established online so- cial network, like Facebook, as a framework for telecare, i.e. for communication to help carers stay in touch with patients and provide support when needed. Based on the cur- rent advances in technologies, e.g. the accessibility of the Internet, the availability of smart devices and the popularity of existing social networks, the use of social media as a platform for healthcare in some form is already gaining interest.

The work by Griffin et al [56] proposed the integration of paradigms in social networks into healthcare, i.e. information sharing, monitoring and message alerts. However, only the adoption of the architecture adapted from social networking technologies was pro- posed, rather than the use of an OSMP. A social network model for health monitoring was proposed by Detmar et al [35], but it did not consider mobile devices, even though it did enable patients to control access to their data. Based on a similar model, work by Ding et al [37] and Ayubi et al [14] employed a monitoring unit, a smartphone and the Face- book platform for monitoring of physical activities: a Facebook account and its security and confidentiality settings were used for authentication of users. Overall, Facebook was proposed as a platform for self-monitoring, sharing and goal setting, but not for remote monitoring and clinical use as we consider in our work.

The work by Fox et al [47] proposed an interface to a PHR platform using a mashup approach, based on online social network technologies. The patients could add people to create their own carer networks and specified which health data record each member could have access to. Moreover, when data values crossed pre-defined thresholds, the system would create alerts sent to relevant social network members to alert them to excep- tional conditions and to take appropriate action, e.g. to send help. Although employing a mashup enables fast development and integration, it requires that the health data be pushed to the provider of the Web components being used, so may raise privacy and se- curity issues.

Although the use of social media has been extended into healthcare domains, there has been relatively little work examining applying the technologies directly for remote monit- oring purposes as described in this thesis. Our work [75, 74, 77, 76] has proposed the use of an OSMP as a key component for future mHealth as well as providing the concept of acarer networkto integrate closed-loop healthcare and enable collaboration in a healthcare social network that encompasses the various actors in a healthcare scenario. Based on the social interaction and distributed functionality in an OSMP, the communication between patients, informal caregivers and formal (professional) caregivers within a healthcare net- work can be improved. According to the work in [77], it is feasible to achieve security and privacy of private health data as well as considerable functionality for mHealth monitoring by the use of a completely open-source OSMP.