eHealth, the use of information and communications technology (ICT) in health care, [1, 2], is a steadily growing area of interest. Technological advances and increasing use of ICT among the general public have driven health care providers to develop new ICT tools and applications for improving the quality of care and services provided to the patients. Sweden has already adopted several eHealth services in practical health care. For example, all primary care units in Sweden today have access to electronic health records , and more than 80% of all prescriptions are now transferred electronically .
Neonatology, the care of the diseases of newborn infants, is a field where eHealth has not yet been applied to any significant extent, but where it could potentially be useful. Because of their immaturity and associated illnesses, premature infants (i.e. infants born at gestational ages 23–37 weeks) often need hospital care at a neonatal intensive care unit (NICU) for several weeks after birth. The illness and prolonged hospitalization of the infant are very stressful for the parents and inhibit the development of a normal parent-infant relationship . Infants who have become sufficiently mature and physiologically stable can be taken care of in the home environment. This usually requires that the infant has reached a postmenstrual age of at least 34 weeks. Caring for the child at home has been shown to be beneficial for families, since the parents can connect with their child better than is possible in the hospital . It also decreases the newborn’s exposure to bacteria prevalent in neonatal intensive care units [6, 7]. In recent years, the Sahlgrenska University Hospital in the Gothenburg area in Sweden has had a home health care program for newborn infants. The medical issues that these children have include poor weight gain or need of tube feeding or supplemental oxygen therapy. During the first weeks at home the family is supported by regular visits 2–3 times per week by a neonatal nurse who weighs and measures the child, helps the parents with the care of the child, and answers questions that come up.
Having the baby at home can initially be difficult for parents who may not yet feel confident taking care of their infant and who often have concerns and questions about the infant’s health and development [8–10]. On the other hand, home visits by nurses represent a large investment of resources, since one nurse can only make a few visits per day.
Already in 1994, a project on using telemedicine/eHealth in the care of prematurely born infants in the home was performed in Gothenburg . In this project a system for monitoring of infants with respiratory distress syndrome in need of oxygen therapy was developed and adapted to a home environment. The system was accepted by the participating families, and the project showed that telemedicine/eHealth applications are adaptable for use in care of infants at home.
Another uncontrolled study where video conferencing was offered to a small group of parents whose premature infants were discharged from the hospital showed that parents experienced video conferencing as positive . The families only had support through the video conferencing system not complemented by visits by a nurse . In the United Kingdom, two studies showed that video conferencing could be used to provide support for parents of children born with congenital heart disease after discharge from the hospital [13, 14]. In this study, video conferencing, which was used to supervise the children visually as well as to communicate with the parents, was found to be more useful than ordinary phone calls [13, 14]. In the Baby CareLink study, families of hospitalized very low birth weight infants could use a videoconferencing module for virtual visits from their home to the NICU and a website to access information on the issues confronting them . This study showed that the use of videoconferencing and Internet support increased the parents’ satisfaction with the care of the infants and facilitated earlier discharge home of the infants . Prototype systems have been developed for monitoring and tracking observations of behavioral and health-related data of premature infants in the home . The FitBaby prototype includes a mobile phone-based application for parents entering observations about their infant’s health as well as a networked database in which these data are stored for clinician access [16, 17]. Estrellita is a prototype system that includes a mobile application that parents use to track and share information and a web interface that parents and health professionals use to view and analyze the resulting data . This system gives parents the ability to easily share information with social networks and health care professionals . NICU-2-HOME is a project in the USA that deals with making the transition from hospital to home easier for the parents with prematurely born infants using a mobile application .
In the present study, we hypothesized that use of eHealth would improve communication between parents of premature infants and home health care nurses and enhance the families’ feeling of confidence in caring for their infant. The families were randomized to one of three study groups, one receiving standard home health care, one receiving home health care supplemented by the use of a customized web-based eHealth system, and a third group receiving home heath care supplemented by video conferencing using Skype to communicate with neonatal nurses. The results show that the telecommunication methods were well accepted by the parents and that their use made parents more confident taking care of their infant at home. Many families also felt that telecommunication could decrease the need of home visits and could therefore make home health care more cost-effective.