pervasive computing

1. Pervasive Healthcare and Wireless Health MonitoringUpkar Varshney

2. Adopting Pervasive Computing for Routine Use in Healthcare

Carsten Orwat, Asarnusch Rashid, Carsten Holtmann, Michaela Wölk, Mandy Scheermesser, Hannah Kosow, Andreas Graefe

IS748 MOBILE AND PERVASIVE COMPUTING Aslı Yazağan & Aslı Günay

1. Pervasive Healthcare and Wireless Health MonitoringUpkar Varshney


Overview

IntroductionPervasive Healthcare Applications and Requirement

- General Requirements- Wireless Requirements

Comprehensive Wireless Monitoring- Health Monitoring using wireless LANs- Health Monitoring using d Hoc Wireless Networks

Context Awareness and Reliability- Context Aware Health Monitoring- Reliable Health Monitoring

- Infrastructure- Health Monitoring and message

Open Issues and Challenges


1. PERVASIVE HEALTHCARE AND WIRELESS HEALTH MONITORING

Introduction

- Pervasive HealthCare: Healthcare to anyone, anytime, anywhere increasing the

both coverage and the quality of healthcare..

- Pervasive Health Monitoring

- Intelligent Emergency Management Systems

- Pervasive HealthCare Data Access

- Ubiquitous Mobile Telemedicine



PERVASIVE HEALTHCARE APPLICATIONS

Introduction

How to provide better healthcare services to an increasing number of people using

limited financial and human resources ?

Wireless technology could improve quality of healthcare

- Patients in cities and rural areas

- Reduce stress and strain on healthcare providers

- Reduce the long-term cost of healthcare services

- Reduce medical errors since medical information is available..



Pervasive Healthcare Applications

-How to provide better healthcare services to an increasing number of people

using limited financial and human resources ?

- Wireless tech. could improve quality of hc

Patients in cities and rural areas

Reduce stress and strain on healthcare providers

Reduce the long-term cost of healthcare services

Reduce medical errors since med inf is available..




Pervasive HealthCare Apps categories:

- Prevention

- Hc maintenance and check-ups

- Short-term monitoring

- Long-term monitoring

- Personalized hc monitoring

- Incidence detection and management

- Emergency Intervention - transportation - treatment




Scenario1:

User has a mobile device that stores all medical information and updates it

pervasively. It uses critical information (blood type, allergies) delivering urgent and

correct medical care.

Scenario2:

To have a normal check-up; a patients could use her mobile device to upload

necessary medical and insurance information reducing the amount of effort.



Pervasive Healthcare Applications | New HC apps comes with Wireless Tech.

Comprehensive Health Monitoring Service

- Patients to be monitored at anytime, in any location

-> Reduce the time between the occurrence of an emergency and the arrival

of needed help.

Intelligent Emergency Management System

- Manage the fleet of ambulance

Health-aware mobile devices

- Detect the certain condition by the touch of a user

Pervasive access to healthcare information

Pervasive lifestyle incentive management

- Give mobile-money to a user if exercises or et health food: leads to healthier

people -> Reduce the hc services costs



Pervasive HealthCare Requirements

General:

- Security of hc data

- Privacy of hc systems

- Portable and usable patient devices

- Reliable wireless infrastructure

- New business model for pervasive hc

- Solutions for management related to insurance payments

Wireless:

- Comprehensive coverage

- Reliable access and transmission of med inf.

- Location management (finding people with matching blood type)

- Support for patient mobility



Comprehensive Wireless Monitoring



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Comprehensive Wireless Monitoring | Health Monitoring using

wireless LANs

1) Patient’s device to locate and join an access point and to transmit vital signs

2) Access point to route the message to hc providers with past vital signs and current

location of the patients

Major issue: Reliability (coverage, signal strength, failure of access point…)



Comprehensive Wireless Monitoring | Health Monitoring using Ad-Hoc

Wireless Networks

Problem: spotty coverage of existing infrastructure oriented wireless network ->

continuous health monitoring is not possible.

Solution: ad-hoc wireless networks

Enables transmitting the vital signals over a short range.

Major Issues: power management-reliable transmission-cooperation between

devices



Context Awareness and Reliability| Context Aware Health Monitoring

HC Monitoring:- Passive vs. Active- Continuous vs. Event-driven- Stationary vs. Mobile patients

H-QoS:- Patient-Centric : reliability of message delivery - Network – Centric : message transmission and # patients supported- HealthCare Professional – Centric : cognitive load and # correct medical decision

MORE WORK needs:- Designing and implementing context-aware protocols- Performance evaluation of hc monitoring system- Actively adapt to context



Health Care Quality of Services (H-QoS)

Context Awareness and Reliability| Reliable Health Monitoring

Infrastructure

Problem: Failure in networks/Coverage limitations/Intermittent access of a device

Solution: Switching to another wireless network

Consider for the infrastructure:

- Intelligence sense of presence of multiple networks

- Deciding which network to switch to

- Devices have the hardware to switch among multiple networks.



Context Awareness and Reliability| Health Monitoring and Message

Delivery

Problem: Difficulties in delivering of signals and delayed medical response

Solution: Work is necessary in creating wireless network architecture and protocols

to support routing and deliver of messages carrying a range of vital signs and

healthcare information.

Consider to improve reliability:

- Use of multipath routing such as multicast or broadcast

- Increased power transmission

- Design of network or middleware protocols for end-to-end reliability.



Open issues and Challenges

Technology issues

- Network support

- How to provide health monitoring in diverse environment

- Sensing vital sign

Medical issues

- How patient care is delivered

- How medical information is represented

- Requirements of diverse patients

Management issues

- Security and Privacy

- Training of health professionals for pervasive hc.

- Legal and regulatory issues

Insurance payments and cost…IS748 MOBILE AND PERVASIVE COMPUTING Aslı Yazağan & Aslı Günay


2. Adopting Pervasive Computing for Routine Use in Healthcare

Carsten Orwat, Asarnusch Rashid, Carsten Holtmann, Michaela Wölk, Mandy Scheermesser, Hannah Kosow, Andreas Graefe


Overview

IntroductionCase Study 1: Stroke Angel

- Purpose - Methodology- System

Case Study 2: MS Nurses- Purpose - Methodology- System

Results & Discussion- User Acceptance

- Perceived medical benefit- Usability- Information requirements

- Organizational Issues- Privacy Issues- Financial Issues


2. ADOPTING PERVASIVE COMPUTING FOR ROUTINE USE IN HEALTHCARE

Introduction

- Healthcare is a promising but challenging application of pervasive computing.

- Multitudinous scenarios exist; yet, they haven’t gone beyond the prototype stage.

- Some factors could be hindering the adoption of pervasive computing systems for

routine use in healthcare.

What are the risks and obstacles- in addition to the benefits and potentials- of

pervasive computing in healthcare?



Introduction

- 2 case studies were conducted with real end users (patients & medical personnel)

in real healthcare settings.

- 2 different healthcare areas were represented: prehospital/hospital &

hospital/posthospital settings.

- Stages from prototype development to routine use were investigated.



Case Study 1: Stroke Angel | Purpose

Adoption of a mobile stroke diagnosis and data transmission device for emergency

medical services (EMS)

System’s purpose: To shorten the time required for the entire process chain.

The major problem in stroke care is insufficient communication between EMS and

hospitals. Critical time is lost when the patient isn’t transported immediately to the

correct hospital or when hospitals aren’t ready for the patient’s arrival.



Discovering and diagnosing the stroke victim

Patient’s admission in a

hospital Treatment

Case Study 1: Stroke Angel | Methodology

- 40 paramedics used five devices equipped with PDA-based software to examine

patients’ health status.

- November 2005 - May 2008

- Bad Neustadt, Germany

- Process analysis: Modeling stroke chain processes to compare time intervals with

and without Stroke Angel.

- User acceptance analysis: Questionnaires & semistructured qualitative interviews

to understand the system’s usability and the impact of social factors (degree of

satisfaction, expectations and needs of each party) in the process chain.



Case Study 1: Stroke Angel | System

- PDA connected to a patient card reader that communicates with a mobile phone

via Bluetooth.

- Paramedics use the Stroke Angel along with conventional medical devices

(e.g. electrocardiographs).

- The Stroke Angel device supports stroke diagnosis via a structured checklist (the

Los Angeles Pre -hospital Stroke Screen, LAPSS).

- Paramedic checks and enters various indicators of neurological problems, such

(e.g. delayed speech or movement) guided by the system.

- Based on this data, the system calculates the possibility of a stroke.




If a stroke is indicated:

- The system initiates an alert and recommends the patient’s immediate admission to

a specialized hospital.

- It sends all relevant data to the hospital via wireless network technologies (General

Packet Radio Service/Universal Mobile Telecommunications System).

- Secure Sockets Layer (SSL) encryption secures data transmission via both client and

server authentication.

- When the new patient data arrives at the hospital, the Stroke Angel server triggers

an alert, which lets clinicians prepare for stroke treatment while the patient is still en

route. The system automatically files a new electronic patient record in the hospital

information system regarding the incoming Stroke Angel patient data and after

confirmation by reception.



Paramedics using the handheld Stroke Angel system in the

field. Ambulances equipped with PDA-based checklists help guide

the paramedics’ examination of patient status; the PDA transfers

examination results and patient data wirelessly to an

appropriate hospital for pre-registration and check-in.




Case Study 2: MS Nurses | Purpose

Adoption of a belt-worn device for movement analysis to support the diagnosis

and therapy of multiple sclerosis (MS).

System’s purpose: To monitor MS patients’ activity patterns and provide

conclusions about the disease’s status and specific MS symptoms.

Clinicians usually measure MS with the Expanded Disability Status Scale (EDSS), a

disability score used to evaluate clinical disease progression. Physicians adjust this

disability score during basic physical examinations. Since these exams provide only

a static image of the disease’s status, more insight into patient activity between

visits is needed.



Monitoring MS patients

Providing conclusions about

MS

Helping doctors to better match

therapy to disease status

Optimizing medication and

exercise

Case Study 2: MS Nurses | Methodology

- April 2007 - November 2008

- Bad Neustadt, Germany (neurological clinic)

- User acceptance analysis: Focus group sessions

- Initial clinical study: 13 MS patients wore ActiBelts as outpatients in their home

environments or as in-patients at the clinic. Project team members wore an ActiBelt

to provide healthy-control-group data for 7 days.

- Financial analysis



Case Study 2: MS Nurses | System

- The ActiBelt system collects long-term gait data to classify everyday activities

(via the triaxial accelerometer embedded in the belt buckle).

- 100 hr battery life allowed to measure activity data 7 days at a time.

- The ActiBelt software lets users manage the belt themselves, including uploading

files to a server for activity analyses via USB or checking on battery or storage status.

- The software on the server conducts an initial processing of the data and calculates

the number, duration, frequency, amplitude, and asymmetry of steps for movement

analysis. The software also estimates the patient’s maximum distances and energy

consumption in order to assess the patients’ physical condition.

- A human analyst checks the results for irregularities, completes the report, and

initiates its transmission to a Web application that doctors can use.





Case Study 2: MS Nurses | System

The ActiBelt system: front side.

The ActiBelt system: rear side.

Multiple MS patients with an Expanded Disability Status Scale

score from 3 (moderate disability, able to walk without

constraints) to 5.5 (disability precludes full daily activity, able to

walk up to 100 m) and members of a healthy control group wore

ActiBelts for seven days at home so that researchers could record

their movements and measure their daily activity.

Results & Discussion | User Acceptance

Usability and information requirements were decisive factors in these particular

environments for both patients and medical professionals.

But, pervasive computing can provide systematic, standardized data collections and

analyses, meeting the healthcare system’s requirements for mandatory

documentation.

It supported medically correct diagnoses by EMS personnel; direct data exchange

between ambulances and hospitals, thereby accelerating stroke therapy; and

more accurate patient registration.




Perceived medical benefit:

For Stroke Angel: Time gains in the rescue chain, which translated into adequate

treatment administered earlier and reduced long-term complications.

So, most participants gave positive feedback.

For MS Nurses: Not completely proven medical benefit, but potential.

It will not only enhance knowledge about MS, but also improve its diagnosis and

therapy. Regarding the doctor-patient interface, a few patients indicated an aversion

to change because they felt technology might replace human treatment.




Usability: Participants generally assessed usability positively in both studies.

For Stroke Angel:

- Problems about hardware (e.g. Small display making it difficult for them to enter data

en route, which can led to time losses that actually offset any time gained).

For MS Nurses:

- Problems about coping with the ActiBelt’s on/off mechanism, often because of their

MS-related motor dysfunctions.

- Flashing on/off signal wasn’t clearly enough. => Not being able to turn the device off

properly can cause unintended battery drain or missing data records.

- Software for data readout required IT capabilities beyond the skills of some medical

staff.




Information requirements:

For Stroke Angel:

- Information and process chain was interrupted few times, but later solved.

For MS Nurses:

- The system indicate unmistakably “what it’s doing and whether it’s working

correctly.”

- No immediate analysis of their personal data.



Results & Discussion | Organizational Issues

For Stroke Angel:

- Conflict between paramedics and emergency physicians: In the German rescue

system, both parties must attend to suspected stroke patients, but the Stroke Angel

system’s diagnose–support function upgrades paramedic responsibility. By using

the system, no emergency physician would be required to decide whether to take a

patient to a stroke unit.

=> Not all the groups involved in the case study accepted this shift.

- Emergency physicians feared that technology would somehow replace their work.

- Paramedics appreciated the enhancement to their role.

- Patients didn’t consider the changed roles to be a problem.



Results & Discussion | Privacy Issues

- Privacy and data protection concerns in both studies.

- Adaptation of a regulatory framework of data protection and privacy legislation.

For Stroke Angel:

- Concerns about a loss of privacy, can be negligible compared to the potential

medical benefit in emergency cases. => Transparent and precise regulation where

data is accessible without consent in emergency cases.

- Concerns about being permanently monitored in daily routines. => Personal

decision about when and to whom their personal data is sent.

-With the prospect of potential long-term medical improvements, participants agreed

to data transmission with consent.



Results & Discussion | Financial Issues

- Funding is crucial for transferring prototypes to routine use in healthcare.

- Both systems in case studies faced financing difficulties in the public healthcare

system’s cost reimbursement schemes.

- Obtaining financing is easier when the system fits into existing reimbursement

structures.

- Increased public funding of clinical studies, public provision of knowledge to

cooperative approaches, and revisions of reimbursement schemes to encourage

innovation are required.

- Many parties can benefit from the deployment of a pervasive computing

innovation, especially when a system is used across different healthcare settings or

regional boundaries. (Yet, contractual agreements can be time-consuming.)



Results & Discussion | Overview

Stroke Angel reduced transportation time and improved preparation at the target

hospital, thereby clearly demonstrating a medical benefit.

MS Nurses showed that the ActiBelt could enhance MS patient therapy.

Both findings were the main reasons why most of the healthcare personnel and

patients accepted the systems, financing could be found, and privacy concerns were

regarded as less important.



Thank you!

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