gms | German Medical Science

53. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e. V. (GMDS)

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie

15. bis 18.09.2008, Stuttgart

Interactive animated multimedia manual for glaucoma home monitoring

Meeting Abstract

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  • Clemens Jürgens - Universitätsaugenklinik, Greifswald, Deutschland
  • Rico Grossjohann - Universitätsaugenklinik, Greifswald, Deutschland
  • Frank Tost - Universitätsaugenklinik, Greifswald, Deutschland

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie. 53. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds). Stuttgart, 15.-19.09.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocMI16-5

The electronic version of this article is the complete one and can be found online at:

Published: September 10, 2008

© 2008 Jürgens et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Introduction and objectives

A constantly aging population leads to an increasing number of elderly patients. As a result, the treatment of chronic illnesses becomes a significant part of daily routine. Glaucoma as a chronic disease demands continuous and efficient therapy management to obtain individually optimized treatment. This requires special conditions for each part of the complex interaction process: documentation, communication, information and decision making. Today’s health care systems are not capable to meet this challenge because they more and more appear to be deficient in flexibility, scalability and complexity. The use of telemedicine offers a new way that may help to establish improved monitoring systems for integrative patient care [1], [2], [3], [4], [5].

In the project TTMV, Teletonometry Mecklenburg-Vorpommern, glaucoma patients were equipped with a home monitoring system for remote glaucoma care. They measured relevant parameters at home and transmitted the data via a telemedical interface to an internet based electronic patient record [4]. To achieve user-friendly device handling and patient centered information combined with transparency and system safety we evaluated the benefits of e-learning where common paper based documentation or oral face-to-face communication failed.

Designing a home monitoring system for managing health and chronic diseases is a complex and multifactorial challenge [6]. One important component is patient information, which can be divided into technical guidance and health education. The latter provides the means by which individuals can be empowered to better manage their own health care and increase pro-active patient participation. To obtain a maximum of valid self-measurements in home monitoring high quality technical documentation that addresses the patient’s needs is essential.

In our project we supplied all patients with a printed version of a detailed manual together with a step-by-step quick user guide and additionally an extensive personal instruction was integrated. From our point of view we spent more than appropriate time and effort to impart the patient all necessary technical skills but the unexpected number of technical problems and patient inquiries at the beginning of our project indicated a need for improvement in this area. Consequently we considered interactive multimedia as a promising method of information for the purpose of patient guidance.


On the basis of the detailed printed manual the information was structured into coherent learning units corresponding to the real operation procedures. The chapters were grouped into different levels which were ordered hierarchically. Furthermore a learning path was defined that connected the learning units to a sequential animation series. Elderly patients suffering from glaucoma are frequently visually impaired hence they have difficulties reading ordinary print. For this reason a script was composed and all information was presented by a professional speaker as audio response. In addition digital audio files can easily be synchronized with visual animation sequences. A user-friendly and legible layout and design was created that featured self-explanatory navigation and patient-centric usability. All devices, operations, actions and features that might occur using the home monitoring system were presented in a professional multimedia studio. Real life photographs of all devices were rendered to 3-dimensional models and integrated into neutral designed animated clips.


We composed a script that covered all procedures and application flows as well as technical principles of the home monitoring devices. The chapters were structured hierarchically to provide access to particular information on request. Furthermore a sequential learning path was defined to allow a complete system overview as an introductory tutorial for novice patients. All procedures were rendered and implemented as animations in a multimedia program which was accessible over the internet and as standalone application for computers or mobile devices. The multimedia manual reduced the number of inquiries and technical problems. In addition the number of measuring errors decreased.


Home monitoring technology is an exciting field opening the door to extend health care into the home and be under the control of the user [7], [8]. Fail-safe handling of home monitoring devices is not an easy job for unskilled patients especially when they are on their own at home without professional support. To assure high quality telemedical care and empower patient motivation a patient centered documentation is fundamentally necessary [2], [4], [9]. Paper based documentation is restricted to present two-dimensional static information and may even be useless for visually impaired patients. However multimedia animations are capable to illustrate complex spatial operations.

Information retrieval in voluminous handbooks is much more difficult and time consuming then in electronic applications with well structured navigation tools [10].

Home monitoring systems have to provide more than data gathering and transmitting devices. Reporting and informing functions are necessary to enhance communication quality between doctors and patients. Documentation and education is needed to keep patient motivation and engagement high. Self-explanatory and patient-centric documentation can be achieved using multimedia e-learning modules. As a next step in the near future the TTMV-eGuide will be extended with interactive animated health education about glaucoma. This will help to continue the optimization process for our glaucoma home monitoring system.


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