MobiSys 2012, Keynote by Paul Jones on Mobile Health Challenges

This year’s ACM MobiSys conference is in the Lake District in the UK. I really love this region in the UK. Already 15 years back when I studied in Manchester I often came up over the weekend to hike in the mountains here. The setting of the conference hotel is brilliant, overlooking Lake Windermere.
The opening keynote of MobiSys 2012 was presented by Dr. Paul Jones, the NHS Chief Technology Officer who talked about “Mobile Challenges in Health”. Health is very dear to people and the approach to health care around the world is very different.

The NHS is a unique intuition that is providing healthcare to everyone in the UK. It is taxation funded and with its 110 billion pounds per year budget it is one of the cheaper (and yet efficient) health care systems in the world. The UK spends about 7% of its national cross product on health care, whereas the US or Germany nearly spend double of this percentage. Beside the economic size the NHS is also one of the biggest employers in the world, similar in size to the US department of defense and the Chinese people’s army. The major difference to other larger employers is, that a most part of the staff in the NHS is highly educated (e.g. doctors) and is not easily taking orders

Paul started out with the statement: technology is critical to providing health care in the future. Doing healthcare as it is currently done will not work in the future. Carrying on will not work as the cost would not be payable by society. In general information technology in the health sector is helping to create more efficient systems. He had some examples that often very simple system help to make a difference. In one case he explained that changing a hospitals scheduling practice from paper based diaries to a computer based systems reduced waiting times massively (from several month to weeks, without additional personal). In another case laptops were provided to community nurses. This saved 6 hours per week and freed nearly an extra day of work per week as it reduced their need for travelling back to the office. Paul argued, that this is only a starting point and not the best we can do. Mobile computing has the potential to create better solutions than a laptop that are more fitting the real working environment of the users and patients. One further example he used is dealing with vital signs of a patient. Traditionally this is measured and when degrading a nurse is calling a junior doctor and they have to respond in a certain time. In reality nurses have to ask more often and doctors may be delayed. In this case they introduced a system and mobile device to page/call the doctors and document the call (instead of nurses calling the doctors). It improved the response times of doctors – and the main reason is that actions are tracked and performance is measured (and in the medical field nobody wants to be the worst).

Paul shared a set of challenges and problems with the audience – in the hope that researchers take inspiration and solve some of the problems 😉

One major challenge is the fragmented nature of the way health care is provided. Each hospital has established processes and doctors have a way they want do certain procedures. These processes are different from each other – not a lot in many cases but different enough that the same software is not going to work. It is not each to streamline this, as doctors usually know best and many of them make a case why their solution is the only one that does the job properly. Hence general solutions are unlikely to work and solutions need to be customizable to specific needs.

Another interesting point was about records and paper. Paul argued that the amount of paper records in hospital is massive and they are less reliable and save as many think. It is common that a significant portion of the paper documentation is lost or misplaced. Here a digital solution (even if non-perfect) is most certainly better. From our own experience I agree on the observation, but I would think it is really hard to convince people about it.

The common element through the talk was, that it is key to create systems that fit the requirements. To achieve this it seems that having multidisciplinary teams that understand the user and patient needs is inevitable. Paul’s examples were based on his experience of seeing the user users and patient in context. He made firsthand the observation, that real world environments often do not permit the use of certain technologies or create sup-optimal solution. It is crucial that the needs to are understood by the people who design and implement the systems. It may be useful to go beyond the multidisciplinary team and make each developer spending one day in the environment they design for.

Some further problems he discussed are:

  • How to move the data around to the places where it is needed? Patients are transferred (e.g. ambulance to ER, ER to surgeons, etc.) and hence data needs to be handed over. This handover has to work across time (from one visit to the next) and across departments and institutions
  • Personal mobile devices (“bring your own device”) are a major issue. It seems easy for an individual to use them (e.g. a personal tablet to make notes) but on a system-level they create huge problems, from back-up to security. In the medical field another issue arises: the validity of data is guaranteed and hence the data gathered is not useful in the overall process.

A final and very interesting point was: if you are not seriously ill, being in a hospital is a bad idea. Paul argued, that the care you get at home or in the community is likely to be better and you are less likely to be exposed to additional risks. From this the main challenge for the MobiSys community arises: It will be crucial to provide mobile and distributed information systems that work in the context of home care and within the community.

PS: I like one of the side comments: Can we imagine doing a double blind study on a jumbo jet safety? This argument hinted, that some of the approaches to research in the medical field are not always most efficient to prove the validity of an approach.

Exoskeletons soon in the real world

Exoskeletons have received some attention over the last years (some with a clear application area in the army), e.g. Robot suit HAL and the BLEEX Project.  
Honda showed now an interesting exoskeletons as walking aid. It is called  „computerized leg device“ or „walking assist device“ and there is an short movie on youtube and it is designed to help people walk. The application areas are probably broad – I expected mainly in care and rehabilitation, but looking around there seem to be more application domains…

How to proof that Ubicomp solutions are valid?

Over the last years there have been many workshops and sessions in the ubicomp community that address the evaluation of systems. At Pervasive 2005 in Munich I co-organized a workshop on Application led research with George Coulouris and others. For me one of the central outcomes was that we – as ubicomp researchers – need to team up in evaluating our technologies and solutions with experts in the application domain and that we stay involved in this part of the research. Just handing it over for evaluation into the other domain will not bring us the insights we need to move the field forward. There is a workshop report which appeared in the IEEE Pervasive Magazine, that discusses the topic in more detail [1].

On Friday I met we a very interesting expert in the domain of gerontology. Elisabeth Steinhagen-Thiessen is chief consultant and director of the protestant geriatric centre of Berlin and professor of internal medicine/gerontology at the Charite in Berlin. We talked about opportunities for activity recognition in this domain and discussed potential set-ups for studies.

[1] Richard Sharp, Kasim Rehman. What Makes Good Application-led Research? IEEE Pervasive Computing Magazin. Volume 4, Number 3. July-September 2005.

Ageing, Technology, Products, Services

Today and yesterday I am visiting a conference that is concerned with ageing – looking at the topic from different perspective (computer science, psychology, medicine, economics) run at the MPI in Berlin. The working group is associate with the the German Academy of Sciences Leopoldina and I was invited by Prof. Ulman Lindenberger who is director at the Max Planck Insititut and works in Lifespan Psychology. The working group is called ageing in Germany (in German).

Antonio Krüger and I represented the technology perspective with example from the domain of ubiquitous computing. My talk „ubiquitous computing in adulthood and old age“ is a literature review in pictures of selected ubicomp systems targeted as an introduction to non-CS people to the domain. The discussions were really inspiring. In one talk Prof. Jim-Chern Chiou from National Chiao Tung Univeristy in Taiwan (the brain research lab) presented interesting dry electrodes that can be used for EEG – but also for other applications where one need electrodes.

Antonio reported an interesting experiment on the navigation/walking performance of people. The basic message is: if you are old and you can hold on to something while walking you gain cognitive resource – if you are young this effect is not given – has quite interesting impliciations [1]. Antonio worked on more in this domain, see [2].
Over lunch we discussed some ideas related to persuasive technologies and Ulman Lindenberg hinted me some relevant authors (Bargh, Gollwitzer) and I found an interesting manual on subliminal prime on the web.
[1] Martin Lövdén, Michael Schellenbach, Barabra Grossmann-Hutter, Antonio Krüger, Ulman Lindenberger: Environmental topography and postural control demands shape aging-associated decrements in spatial navigation performance. Psychology and Aging, 20, 683-694, 2005 http://www.ncbi.nlm.nih.gov/pubmed/16420142
[2] Aslan, I., Schwalm, M., Baus, J., Krüger, A., and Schwartz, T. 2006. Acquisition of spatial knowledge in location aware mobile pedestrian navigation systems. In Proceedings of the 8th Conference on Human-Computer interaction with Mobile Devices and Services (Helsinki, Finland, September 12 – 15, 2006). MobileHCI ’06, vol. 159. ACM, New York, NY, 105-108. DOI= http://doi.acm.org/10.1145/1152215.1152237

Have Not Changed Profession – Hospitals are complex

This morning we had the great opportunity to observe and discuss workflows and work practice in the operating area in the Elisabeth hospital in Essen. It was amazing how much time from (really busy) personnel we got and this provided us with many new insights.

The complexity of scheduling patients, operations, equipment and consumables in a very dynamic environment poses a great challenges and it was interesting to see how well it works with current technologies. However looking at the systems used and considering upcoming pervasive computing technologies a great potential for easing tasks and processes is apparent. Keeping tracking of things and people as well as well as documentation of actions are central areas that could benefit.

From a user interface perspective it is very clear that paper and phone communication play an important role, even in such high-tech environment. We should look a bit more into the Anoto Pen technology – perhaps this could be an enabler for some ideas we discussed. Several ideas that relate to implicit interaction and context awareness (already partly discussed in the context of a project in Munich [1]) re-surfaced. Similarly questions related to data access and search tools seem to play an interesting role. With all the need for documentation it is relevant to re-thing in what ways data is stored and when to analyses data (at storage time or at retrieval time).

One general message from such a visit is to appreciate people’s insight in these processes which clearly indicates that a user centered design process is the only suitable way to move innovation in such environments forward and create by this ownership and acceptance.

[1] A. Schmidt, F. Alt, D. Wilhelm, J. Niggemann, H. Feussner. Experimenting with ubiquitous computing technologies in productive environments. e & i Elektrotechnik und Informationstechnik, Springer Verlag. Volume 123, Number 4 / April, 2006. pages 135-139

The real world is complex and fast – visit to a hospital

In contrast to us people in the medical domain seem to start early in the morning. In the process of preparing a project proposal we visited the Elisabeth Hospital in Essen. We got the chance to see some invasive heart exams first hand.

It is impressive how well such complex processes run and how quick the staff can assess the conditions. Looking for potential to make theses processes easier is a touch challenges – espcially if you do not do this by sitting at your desk but if you want it to be realistic. In the discussion with the head nurse it became apparent that user centred design is probably the only way to really make a difference.

Processes are structures but nevertheless the real world is complex and messy. One thing we saw even in our short visit is that technology introduced must not make things slower – not even a single step.

In our conclusion we found a number of interesting issues – in particular with regard to the electronic patient record – that are worth while to push forward.

Personal mobile health – Nintendo GlucoBoy

Recently an interesting mobile health product was launched: the glucoboy – http://www.glucoboy.com/ . It is designed as an add-on to the Nintendo Gameboy. The basic idea is to combine blood glucose measuring for children and video gaming.

This product shows that an in-depth understanding of the problem domain can create novel interactive products (in this case the idea was conceived by a parent with a direct insight into the problem). For user interface engineering we see again a clear value of contextual enquiry (or at least contextual understanding) combined with a clever utilization of technology.