Prolonged loneliness in older adults increases the risk of dementia, cardiovascular diseases, and premature death. However, timely detection and behavioral pattern analysis are challenging due to the slow progression of loneliness and diverse individual lifestyles. To address these barriers, we propose SMILE, an end-to-end framework for sensor-driven detection and counterfactual pattern analysis of loneliness. Our approach uses non-intrusive sensors to passively observe behavior and build a personalized profile over time. When SMILE detects meaningful changes in activity patterns, it employs generative models to produce counterfactual sensor profiles—synthetic representations of behavior predicted to result in lower loneliness scores. Suggested pattern changes are identified as the difference between observed and counterfactual profiles, highlighting the behaviors most associated with loneliness. We conducted a 6-month feasibility study with 18 participants from the United States and 15 from Japan to develop and evaluate SMILE. Our framework integrates a Time-series Transformer (TST) model for loneliness detection, which achieved 96.25% accuracy, and a diffusion model for generating behavioral explanations, which outperformed a baseline by up to 76.69%. These findings highlight the potential of SMILE to support sensor-driven, personalized loneliness detection and behavioral explanation in aging populations.

We introduce MentalChat16K, an English benchmark dataset combining a synthetic mental health counseling dataset and a dataset of anonymized transcripts from interventions between Behavioral Health Coaches and Caregivers of patients in palliative or hospice care. Covering a diverse range of conditions like depression, anxiety, and grief, this curated dataset is designed to facilitate the development and evaluation of large language models for conversational mental health assistance. By providing a high-quality resource tailored to this critical domain, MentalChat16K aims to advance research on empathetic, personalized AI solutions to improve access to mental health support services. The dataset prioritizes patient privacy, ethical considerations, and responsible data usage. MentalChat16K presents a valuable opportunity for the research community to innovate AI technologies that can positively impact mental well-being. The dataset is available at https://huggingface.co/datasets/ShenLab/MentalChat16K and the code and documentation are hosted on GitHub at https://github.com/PennShenLab/MentalChat16K.

OBJECTIVES: To describe the prevalence and trends in the use of social media over time and explore whether social media use is related to better self-care efficacy and thus related to better mental health among United States older adults with multimorbidity. MATERIALS AND METHODS: Respondents aged 65 years+ and having 2 or more chronic conditions from the 2017-2020 Health Information National Trends Survey were analyzed (N = 3341) using weighted descriptive and logistic regression analyses. RESULTS: Overall, 48% (n = 1674) of older adults with multimorbidity used social media and there was a linear trend in use over time, increasing from 41.1% in 2017 to 46.5% in 2018, and then further up to 51.7% in 2019, and 54.0% in 2020. Users were often younger, married/partnered, and non-Hispanic White with high education and income. Social media use was associated with better self-care efficacy that was further related to better mental health, indicating a significant mediation effect of self-care efficacy in the relationship between social media use and mental health. DISCUSSION: Although older adults with multimorbidity are a fast-growing population using social media for health, significant demographic disparities exist. While social media use is promising in improving self-care efficacy and thus mental health, relying on social media for the management of multimorbidity might be potentially harmful to those who are not only affected by multimorbidity but also socially disadvantaged (eg, non-White with lower education). CONCLUSION: Great effort is needed to address the demographic disparity and ensure health equity when using social media for patient care.

Research on smart home monitoring for older adults has predominantly focused on systems whose data and alerts are directed towards family members, caregivers, or healthcare providers. Older adults have expressed interest in engaging with these systems by seeing and using their data, but they are often limited to a passive role as subjects of monitoring. This paper presents qualitative results of a longitudinal smart home project with older adults living independently in the community. Based on interviews conducted throughout the 2.5-year study with 12 participants, we report on their lived experiences of having the monitoring system in their homes and on how they reflected on the data collected by the system. The results show how participants were able to extract meaningful information from the monitoring data without finding the system invasive or intrusive. Specifically, older adults exhibited interest in data that they found indicative of living an active lifestyle, such as time spent outside the home. Drawing from critical literature on active aging, we discuss implications for incorporating peer comparisons to support reflection on personal health data without reinforcing a deficit narrative of aging.

OBJECTIVE: With age, older adults experience a greater number of chronic diseases and medical visits, and an increased need to manage their health information. Technological advances in consumer health information technologies (HITs) help patients gather, track, and organize their health information within and outside of clinical settings. However, HITs have not focused on the needs of older adults and their caregivers. The goal of the SOARING (Studying Older Adults and Researching their Information Needs and Goals) Project was to understand older adult personal health information management (PHIM) needs and practices to inform the design of HITs that support older adults. MATERIALS AND METHODS: Drawing on the Work System Model, we took an ecological approach to investigate PHIM needs and practices of older adults in different residential settings. We conducted in-depth interviews and surveys with adults 60 years of age and older. RESULTS: We performed on-site in-person interview sessions with 88 generally healthy older adults in various settings including independent housing, retirement communities, assisted living, and homelessness. Our analysis revealed 5 key PHIM activities that older adults engage in: seeking, tracking, organizing, sharing health information, and emergency planning. We identified 3 major themes influencing older adults' practice of PHIM: (1) older adults are most concerned with maintaining health and preventing illness, (2) older adults frequently involve others in PHIM activities, and (3) older adults' approach to PHIM is situational and context-dependent. DISCUSSION: Older adults' approaches to PHIM are dynamic and sensitive to changes in health, social networks, personal habits, motivations, and goals. CONCLUSIONS: PHIM tools that meet the needs of older adults should accommodate the dynamic nature of aging and variations in individual, organizational, and social contexts.

OBJECTIVE: The goal of this study was to explore whether features of recorded and transcribed audio communication data extracted by machine learning algorithms can be used to train a classifier for anxiety. MATERIALS AND METHODS: We used a secondary data set generated by a clinical trial examining problem-solving therapy for hospice caregivers consisting of 140 transcripts of multiple, sequential conversations between an interviewer and a family caregiver along with standardized assessments of anxiety prior to each session; 98 of these transcripts (70%) served as the training set, holding the remaining 30% of the data for evaluation. RESULTS: A classifier for anxiety was developed relying on language-based features. An 86% precision, 78% recall, 81% accuracy, and 84% specificity were achieved with the use of the trained classifiers. High anxiety inflections were found among recently bereaved caregivers and were usually connected to issues related to transitioning out of the caregiving role. This analysis highlighted the impact of lowering anxiety by increasing reciprocity between interviewers and caregivers. CONCLUSION: Verbal communication can provide a platform for machine learning tools to highlight and predict behavioral health indicators and trends.

Objective: Although family and friends (FF) often play a significant support role in the health of older adults (OA), we know little about their role in personal health information management (PHIM). To address this gap and inform the design of PHIM tools, we describe the work, needs, and barriers of FF in the context of PHIM for OAs. Methods: We conducted semi-structured telephone interviews with 52 FF identified by OA as being important in their health and PHIM. We analyzed interview transcripts for themes about FF information work, barriers, and support needs. Results: FF play a supportive role in OA health maintenance, medical encounters, decision making, and daily activities. Monitoring, the ongoing process of seeking information related to the OA status, emerged as a key activity comprised of 3 phases: detection, interpretation, and action. Barriers to monitoring included OA choices and constraints, FF constraints, and difficulty with technological tools, resources, health information exchange between providers, social network dynamics, and physical distance. Conclusions: FF frequently monitor for change in OA well-being, seeking up-to-date information to facilitate support of OA PHIM. Health information technology tools designed for FF can support all phases of monitoring by providing: (1) timely and granular levels of access to OA health information as the OA ages; (2) tailored health education for FF that is based on OA clinical data; and (3) networking platforms that integrate delegation, volunteering, and relevant resources, along with tools to facilitate support of OA appointment calendars and medication management. Such tools could reduce the burden of PHIM for OA and their loved ones.

In response to a perceived caregiver shortage and need to support aging in place, telehealth home care systems are being developed to provide remote care and monitoring to older people. Though research has examined the experiences of teleoperators delivering care through these systems, we know less about the experiences of older adults receiving this care. We report findings from a three-month study of a tablet-based telehealth home care system that provides support for aging in place. We find that there is a mismatch between the designer's conception of how care should be delivered and the ways that participants were interested in using the system. This mismatch exists in four areas: participants' interest in getting to know the human teleoperators and rejecting the virtual avatar, interrogating the interface to figure out the inner workings of the platform, pushing for a more symmetrical relationship, and negotiating the relation work that they were willing to perform in the "sacred space" of their homes. We draw on the concept of heteromation to understand the political dimensions of telehealth aging in place technologies. We also provide implications and future directions for technologies requiring relation work as well as the design of avatar-based remote companionship.

Robots are seen as a potential solution to the perceived needs of the aging population. Thus far, research has primarily focused on robotics for the functional and emotional support of older adults. Robotic pets have been developed primarily for the older adult who is perceived as lonely and isolated, and fears have consequently arisen that robots will replace human caregivers and deceive older adults into developing relationships with them. Missing is the perspective of older adults on the ethics of and potential uses for robotic companion pets. In this study, we conducted focus groups with 41 older adults. We discuss concepts raised by focus group participants such as giving into the fiction of the robotic pet, the social role of the robot, and the role of reciprocity in building a relationship with a robotic pet. We present resulting considerations for new directions for robotic pet design for older adults.

Advances in information technology (IT) have introduced new design approaches that support health care delivery and patient education. Such advances enable a fundamental redesign of health care processes based on the use and integration of electronic communication at all levels. Healthcare IT has the potential to empower patients and support a transition from a role in which the patient is the passive recipient of care services to an active role in which the patient is informed, has choices, and is involved in the decision-making process. New IT tools can enhance and supplement communication between health care professionals and patients. As a result, many informatics researchers and system designers who previously focused on designing IT applications that addressed the needs of health care providers and institutions are shifting toward patient-centered applications. Previous data models included episodic patient encounters as one type of health care transaction but did not capture the life course of the individual patient or consistently take an approach to ensure continuity of care. New technologies and advances in informatics research will enable support of patients as active consumers in a health care delivery system that is evolving from an institution-centric to a patient-centric model.1 Information technology tools can support interventions focusing on disease management and wellness. A disease management intervention is defined as “a set of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant.”2 Disease management programs aim to support patient-specific care plans and the provider-patient relationship via evidence-based guidelines. They focus on prevention of deterioration and/or complications. In the context of consumer empowerment, the paradigm of disease management can be extended to wellness management, where the focus is on the maintenance and improvement of the health status of any individual. Patient-centered applications are defined as systems that enable a partnership among practitioners, patients, and their families (when appropriate) to ensure that procedures and decisions respect patients' needs and preferences. Developers should solicit patients' input regarding the education and support that patients require to make decisions and participate in their own care.3 Such applications bridge clinical and nonclinical sectors and include both individual and population health-oriented tools. They encompass different communication channels such as web-based systems, portable monitoring tools, and mobile devices. The Knowledge in Motion Working Group of the American Medical Informatics Association coalesced from the merger of three previous working groups: Internet, Telehealth, and Mobile Computing. The working group produced this white paper to define the key principles and challenges for designers, policy makers, and evaluators of patient-centered technologies designed for disease prevention and management. The paper reviews current and emerging trends; highlights challenges related to design, evaluation, reimbursement, and usability; and reaches conclusions for next steps that will advance the domain. The Internet provides a platform for consumers to access health information. The number of web-based patient education sites that provide access to information related to patients' conditions has been increasing. The web enables patients communication between patients and health care providers4 or among patients and/or community members. Internet technologies have been utilized for disease management in many clinical areas, e.g., in asthma and diabetes management, where frequent monitoring can lead to early detection of potentially critical situations and timely intervention. In this context, a distinction needs to be made between applications that support pure self-care (without involvement of a health care provider) and applications that provide IT- enabled provider support of self care or disease co-management (vs. the traditional model of provider-administered and controlled care delivery). One example of IT-enabled self care is the home asthma telemonitoring5 system, which provides patients with continuous individualized help in the daily routine of asthma self-care. Extensive evaluations of the CHESS system (Comprehensive Health Enhancement Support System), an interactive computer system containing information, social support, and problem-solving tools for different patient groups (e.g., breast cancer patients, HIV patients), show the potential of web-based applications to increase disease knowledge, education, and social support.6 Most Internet-based health intervention studies have measured immediate, IT-focused nonclinical outcomes of Internet utilization for disease management, including features accessed by the patients,7 patient experience and satisfaction,8 or general health portal reliability.9 In general, it is difficult to characterize the effect of patient-centered applications compared with other interventions due to difficulty in teasing out the independent contribution of the technology. A systematic literature review focusing on the effects on health and social outcomes of computer-based peer-to-peer communities and electronic self support groups10 came to a similar conclusion, indicating that no robust evidence exists yet for the effects of such communities. Mobile health applications focus on serving the needs of the user by providing widespread access to relevant information and/or remote data capture, thus eliminating the need for the user to be physically linked to a network or restricted to a specific geographic location. The use of mobile IT devices such as personal digital assistants (PDAs) and cellular phones in health care is increasing. For health care practitioners, the use of mobile IT can bring additional resources to the point of care and can change the location of that point of care. Earlier research into using mobile IT devices, such as PDAs or cellular phones, emphasized the collection of data from the patient to facilitate clinician decision making.11 There are a few applications that provide real-time decision support to patients as well.12 Despite the movement toward patient-centric applications, most applications described in the literature follow the old model of decision-making in which the patient is a receiver of instructions rather than a participant in the management process.13 In these applications, it is assumed that patients will comply with recommended interventions and there is little follow-up to examine whether and how the patient did so.14 Patient-centered mobile health care applications have often targeted the areas of asthma,15 diabetes,16 and chronic obstructive pulmonary disease (COPD).17 Mobile health promotion or wellness applications have primarily addressed smoking cessation,18 nutritional intake,19 and vaccinations.20 In the popular media but not yet in scientific literature, there have been descriptions of how MP3 players21 and iPods22 might promote wellness activities and patient education. As noted by Moen and Brennan,23 consumers use complex strategies for managing their health information (storing information throughout multiple spaces in their household, recording with different media, and organizing data based on perceived urgency of the information), and technology designers should incorporate these strategies into their mobile IT designs for health management. Home telehealth applications (also known as telehomecare applications) utilize telecommunication and videoconferencing technologies to enable a health care provider at a clinical site to communicate with patients in their homes. Such an interaction via videoconferencing is called a virtual visit. In this context, the term actual visit is used to describe the traditional visit of the health care provider to the patient's home that includes a face-to-face interaction. In addition to the use of videoconferencing to enhance interactions, telehomecare applications utilize vital sign and other reporting devices that allow patients to become more involved and in many cases to oversee the monitoring process. Johnston et al.24 evaluated the use of remote video technology and monitoring devices in the home and determined that it achieved cost savings and improved access to home care support while producing no differences in clinical outcomes when compared with traditional care. A recent clinical trial at the Veterans Affairs Palo Alto Health Care System explored the use of a simple telephone-based device to ask patients a series of questions related to their health on a daily basis25 and demonstrated a significant decline in readmissions as a result of this simple asynchronous monitoring process.25 Health-related outcomes, including patient compliance, morbidity, and mortality, have been studied less often. Most such studies have had a maximum follow-up of one year and therefore are not able to evaluate long-term outcomes. The usability of mobile health systems is a key factor in the acceptance and diffusion of such technology in disease management and wellness promotion. In this context, four factors need to be addressed: user-friendliness, usability, user competence, and confidence.26 The first two factors deal mostly with the type of mobile technology (hardware matters such as size, noise, aesthetic presence, and obtrusiveness, and software matters such as user interfaces and device operation), whereas the last two factors relate more to users and their perceptions. The rate and impact of errors, at all steps, e.g., data acquisition, use of sensors, manual data entry, networking, and support services, must be analyzed. Furthermore, end users need to be confident in the system's performance. The latter involves challenges such as minimizing false positive alerts, protecting data security, maximizing diagnostic accuracy, etc. Special design considerations should apply when developing systems for the elderly or for other populations with functional limitations.27 Patient-centered applications often require the secure exchange of clinical data via electronic messages from different patient record systems to consolidate the disparate data required for disease management. To allow the correct interpretation of the exchanged information and adequate responses by the receiver, both a semantically sound and technically feasible set of standards are required. Goossen28 defined a framework of relevant standards for using clinical information in IT for five core areas: clinical, vocabulary, messages, work flow, and technical standards. Clinical standards, such as guidelines indicating the professional care that is appropriate for specific conditions, must be reflected in the domain knowledge included in programs for disease management and wellness. A second type of standard concerns terminologies in different formats and usually developed for specific purposes, such as clinical documentation, comparison of data, or statistical reporting. Ultimately, a broader goal of standardized vocabulary is the collection of more accurate and appropriate population and public health data to support decision making. The third type of standards focuses on the electronic exchange of information within and/or between health information systems; the classic example is Health Level Seven (HL7),29 which provides standards for the exchange, management, and integration of data that support clinical patient care and the management, delivery, and evaluation of health care services. Current HL7 v3 message models, e.g., for patient care, can represent the patient as author of health information, thus respecting self-care responsibilities. The fourth type of standard deals with work flow of health care processes. These standards describe the details of the care plan, stakeholders and timeline, required interactions, and transactions. For example, in home care, there is a detailed care plan that dictates the number of home care visits, their goals and who conducts them (registered nurse, nursing aid, social worker, etc.), and rules for specific processes (e.g., capturing of vital signs). Finally, technical standards need to be addressed. Numerous technical standards are available, including infrastructure, networking, and security issues. Particularly relevant for disease management applications are the Internet protocol (TCP/IP) for the infrastructure and Extensible Markup Language (XML) for the technical expression of messages. Investments in patient-centered IT-based applications are based in part on expectations of improving interorganizational networks, reducing costs, controlling resource allocation, and achieving a higher standard of quality of services promoting disease management and wellness.30 Innovators face major challenges in meeting increasing demands for health care services with limited resources. A major impediment for investments in IT applications, however, may be a lack of evidence of their economic impacts31 on end users, organizations, stakeholders, and society as a whole. Although pilot studies indicate clinical efficacy of patient-centered IT-based applications at the intraorganizational level,32 less is known about the cost effectiveness of such applications. Evaluation studies often are limited to hypothetical discussions, rather than actual analyses, of the potential value of patient-centered applications to consumers and methods for developing business models that transition from a payment-per-visit model (prospective payment principle) to a payment-per-episode-of-care model, or for quantifying the direct cost of the technology in use.33 Any economic evaluation will need to recognize that the system we are dealing with is not just an information system but an entire grid of interlocking actors and work processes34 whose boundaries must be determined for the sake of the evaluation. The majority of economic evaluations performed to date provide no conclusive answers about how to combine efficiency, effectiveness, and business process benefits derived from IT implementations involving patient-centered care.35 More recent intraorganizational studies have tried to evaluate savings due to productivity improvement and cost reductions. Other models of transformational benefits of clinical IT36 use frameworks such as return on investment and focus on the health care organization's perspective. However, many such models failed to represent IT-induced benefits apart from direct savings (such as patient empowerment, increased patient satisfaction) and do not include the efforts needed to enable the change, namely, overcoming user resistance, training and technical support, and achieving management support. Solid economic evaluations of patient-centered IT-based applications have to be performed as a comparative analysis of alternative courses of actions in terms of both their costs and their consequences. The main problem in evaluating patient-centered applications today often involves tracing and delimiting the consequences from an IT-based application. Benefits may occur only after a time lag, and sometimes they may arise as unintended consequences of the system.37 The public policy issues related to the use of IT to promote disease management and wellness are the same as those that arise for the use of IT in health care in general and involve several levels (state, federal) as well as numerous stakeholders. Specifically, these issues relate to access to care; the quality, safety, and efficacy of the delivered services; who will pay for that care and how much; and how to maintain the privacy and confidentiality of information. Introduction of IT adds a new set of cost drivers to these issues and raises questions about the benefits derived from these new technologies. Although the use of IT for patient-centered management has shown positive benefits for patients in selected experimental settings, the widespread use of IT for disease management might paradoxically reduce access to care via two mechanisms. The first of these reflects the extent to which the use of IT increases the cost of care. For example, a hypertensive patient's blood pressure can be monitored at home with a simple $50 sphygmomanometer. The same monitoring can also be performed by a home telehealth unit costing 10 to 100 times as much that automatically reminds the patient and transmits the results to a central location for evaluation. Although the latter technocentric approach may lead to higher quality of care and better patient outcomes, it also consumes considerably more financial resources. In a constrained spending environment, fewer patients will have access to this more advanced and potentially more beneficial care. The second way that access to care may be increasingly restricted results from infrastructure requirements becoming more of a technology may be restricted by the lack of access to at the point of care in the The has a number of and with for many of the in this In the of the for and has the that videoconferencing and related technologies can be used to provide appropriate care geographic but that reimbursement, from a to the site where the patient is will be to is for a face-to-face visit. There is only a for the costs of the technologies when used in a in the of home care, for virtual to the and remote monitoring at a set that no specific for the costs of the is from for services to for outcomes for and it is to that these technologies will have to to the same public policy from concerns about the and efficacy of health care devices. The and has the for the and efficacy of all such devices in the Any devices used for monitoring of disease conditions, such as are to IT is as an device may have a impact is the evolving on software that is used for purposes, but is not to a such as Medical systems, decision support systems, and disease management is a significant public policy that at the date of this major review at the as of the of who can provide such services, of services are and in many how much can be for those services. provides for the to ensure that health care in areas, the education system, and public have access to services including the One of the is to allow the of a Internet where users must pay an additional for Although this is perceived as a way to quality of services, the is that it will also increase the digital between who can better infrastructure and the applications that require them and those who that this might rather than help to health public policy to delivery of health care In many health care the site of is to be where the not the is In any in which for direct care is and IT is used to bridge geographic this distinction can become an In the it has been a significant to the diffusion of many IT-based One emerging to the may be the of of promoting of in one as in all The literature to date on the of patient-centered systems has focused on technical Although considerations related to of such systems are and more there have been fewer studies or have on patients' in knowledge of their own health (e.g., for breast cancer can lead to and/or can have a impact on quality of as well as between the patients and and between patients and researchers public health have guidelines for protecting the privacy of electronic clinical is a process that with to data when they are and for the of the protecting the data they with security, data must become increasingly about their collection and it is well known in the data security community that security security on a key of their from the are more than security to review and a by provides a patient with or other services from the of of the of the traditional is an for The of Healthcare with in and on health care information technology a of the of telehealth and mobile health More on details the in just this one of A developing of work in the mobile device issues of data but not yet of mobile technologies at to health care providers in exchange for the or to and use information white paper of the system and issues related to patient-centered disease management applications. clinical show and indicate that IT has potential to to improving patient However, more research is including experimental studies and economic studies from including design (e.g., to evidence of the effectiveness of patient-centered applications is required to the benefits of IT-enabled care can be the by of health care professionals must be addressed. work on standards and issues will facilitate health applications. Although these issues are they more critical for patient-centered which often require data and exchange among a set of and software applications and stakeholders The usability and of patient-centered applications and devices should be addressed early in the design into patient's and The of patient For researchers and system designers, the need exists for and that can patient or decision making. involves review and of many tools, for example that patient and patient in the context of a specific as well as the design of new tools. For the is to design patient education and that will take of the to a patient-centered A systematic of the issues of clinical data will help to ensure that patient data to Finally, the issues involved with the of mobile IT to health care are many and System designers should incorporate and privacy is to whether and how issues related to IT should be into the clinical for The and all of the Working Group for of this work and providing and

In order to determine whether videophones are appropriate communication tools for psychometric assessments, we need to determine whether the quality of videophones is adequate to enable this type of assessment or whether it places a burden on the communication. The purpose of this study is to measure the subjective quality of video and audio features of commercially available videophones in the context of a psychometric assessment session. We recruited 52 subjects who used the videophone to participate in a psychometric assessment using the Perceived Stress Scale. After each session, participants filled out the ITU-T P.920 that assesses the context-specific quality of the video-call. Findings indicate that the overall audio and image quality of the video-call was satisfactory and participants perceived the videophones as useful in the context of psychometric assessment. These findings strengthen the call for use of video mediated communication in home and hospice settings and disease management.

The literature of home telehealth technology recommends that systems be designed to minimize their obtrusiveness to end users. However, this term is neither explicitly defined nor consistently used. This paper presents a definition of the concept of obtrusiveness. Within this definition, twenty-two categories of what may be perceived as obtrusive in home telehealth technology are proposed based on a review of the literature. These categories are grouped into eight dimensions. This effort represents an initial step toward developing measures of obtrusiveness associated with home telehealth technology. A validated and reliable instrument would allow for evaluation of individual applications as well as theory-building across applications.

An essential part of health informatics is telemedicine, the use of advanced telecommunications technologies to bridge distance and support health care delivery and education. This report discusses the integration of telemedicine into a medical informatics curriculum and, specifically, a framework for a telemedicine course. Within this framework, the objectives and exit competencies are presented and course sections are described: definitions, introduction to technical aspects of telemedicine, evolution of telemedicine and its impact on health care delivery, success and failure factors, and legal and ethical issues. The emphasis is on literature review tools, practical exposure to products and applications, and problem-based learning. Given the rapid advances in the telecommunication field, keeping the course material up to date becomes a challenge for the instructor who at the same time aims to equip students with the knowledge and tools they will need in their future role as decision makers to detect a need for, design, implement, maintain, or evaluate a telemedicine application.

In the last several years, the amount of clinical information retrievable on the Web has increased, and a great number of patient education sites have been developed.These allow patients to access information related to their medical conditions but do not provide protection from misleading or inaccurate data posted for commercial or other reasons.The Internet can also provide a tool for communication between patients and health care providers.Message boards and online surveys allow patients to transmit data to providers for evaluation of their conditions.Online questionnaires support the detection of trends in patients' conditions that might require special attention and, in general, support remote clinical monitoring of signs and symptoms.Although the Internet seems to have the potential to revolutionize the process of health care delivery and empower patients to become more active in the care process, the fastest growing segment of the U.S. population-i.e., people over the age of 50 years 1 -are at a disadvantage because designers of both software and hardware technology fail to consider them as a potential user group. 2 The design of a usable Web-based information system for healthy users who are familiar with computer technology is a challenge.When a system needs to address age-related constraints and the functional limitations of inexperienced users, it becomes even more difficult.Designers of a system for elderly patients should aim to increase its functional accessibility.The term "accessible design" refers to maximizing the number of potential customers who can readily use a product.3 A "functional limitation" describes a "reduced sensory, cognitive, or motor capability associated with human aging, temporary injury, or permanent disability that prevents a person from communicating, working, playing, or simply functioning in an environment where other people in the population can function."3 In this review, we gather published guidelines for the design of Web-based clinical systems for elderly patients, identify literature gaps, and discuss additional considerations.The recommendations are intended to organize the conception, implementation, and evaluation of such Web-based systems and can offer concrete support for decision making during the design process.