Is 'Pervasive Healthcare' old wine  on a new bottle – or is it a real, but emerging, research discipline? Jakob E. Bardram
The Age Tsunami US Demand/Supply of Nurses
Source :  Eric Dishman. Inventing wellness systems for aging in place,  IEEE Computer  37:5 (May 2004), 34–41..
Changing the Centralized Model of Healthcare <ul><li>Acute  -> Continuous </li></ul><ul><li>Hospitalization -> Home & out-...
Pervasive Healthcare <ul><li>Application of pervasive computing, ubiquitous computing, proactive computing, ambient intell...
Agenda <ul><li>Historical Roots </li></ul><ul><ul><li>Biomedical Engineering, Medical Informatics, UbiComp </li></ul></ul>...
Historical Roots
Biomedical Engineering – BME <ul><li>Biomedical engineering (BME)  is the application of engineering principles and techni...
Biomedical Engineering
Medical Informatics – MI <ul><li>Medical informatics (MI)  is the intersection of information science, computer science an...
Medical Informatics <ul><li>Hospital Information Systems </li></ul><ul><li>Electronic Patient Record </li></ul><ul><ul><li...
Ubiquitous Computing PC Mini Mobile Internet Mainframe Ubiquitous
Ubiquitous Computing <ul><li>Embedded / invisible / ambient computing </li></ul><ul><li>From 1:1 to N:N computing </li></u...
Pervasive Healthcare – Characteristics <ul><li>Technology </li></ul><ul><ul><li>Sensor technology and networks </li></ul><...
Pervasive Healthcare – Research Themes <ul><li>Monitoring </li></ul><ul><li>Assistive Technologies </li></ul><ul><li>Preve...
Medication I
Medication II
Telemedicine?
Pervasive Monitoring Wireless Monitors Bodyworn Monitors Mobile Monitoring Body Sensor Network MyHeart Project
Challenges in Monitoring <ul><li>Robust measurement and processing methods requires access to large and representative rea...
Example I ElderTech – Technologies for Elders
<ul><li>Purpose </li></ul><ul><ul><li>Self-care and independent living </li></ul></ul><ul><ul><li>Easy communication with ...
Technical Setup
Findings – Elders <ul><li>Usability </li></ul><ul><ul><li>Scale & BP monitor used frequently </li></ul></ul><ul><ul><li>Th...
Findings – Healthcare Workers <ul><li>Administration </li></ul><ul><ul><li>Collaboration book </li></ul></ul><ul><ul><li>I...
Lessons learned about designing AT <ul><li>Vital sign monitoring is ‘interesting’ </li></ul><ul><ul><li>but introduces a h...
Example II The Interactive Hospital – Supporting Awareness in a Operating Ward
Whiteboards in Hospitals Source :  J.E. Bardram, Temporal Coordination - On Time and Coordination of  Collaborative Activi...
Affordances of Whiteboards <ul><li>Core Roles of Whiteboards in Hospitals </li></ul><ul><ul><li>Visibility </li></ul></ul>...
Design of AwareMedia <ul><li>” Putting the schedule back on the wall” </li></ul><ul><ul><li>Public and shared social aware...
AwareMedia User Interface
AwareMedia Technology & Architecture <ul><li>Technologies </li></ul><ul><ul><li>Media Spaces </li></ul></ul><ul><ul><li>Sc...
1. Spatial Awareness <ul><li>OR Space </li></ul><ul><ul><li>Video </li></ul></ul><ul><ul><li>Status </li></ul></ul><ul><ul...
2. Temporal Awareness <ul><li>OR Schedule </li></ul><ul><ul><li>Operations </li></ul></ul><ul><ul><li>OR Teams </li></ul><...
3. Social Awareness <ul><li>Context </li></ul><ul><ul><li>Picture, Name & Initials </li></ul></ul><ul><ul><li>Location </l...
Deployment <ul><li>Site </li></ul><ul><ul><li>OR Ward, Bed Ward, Recovery </li></ul></ul><ul><ul><li>Supports 3 ORs, 30-50...
Hospital
Operating Ward
AwareMedia in Use <ul><li>Data collection </li></ul><ul><ul><li>Observations, Interviews, Data Logging </li></ul></ul><ul>...
Example III Context-aware Patient Safety  in the Operating Room
Patient Safety <ul><li>Institute of Medicine: “To err is Human” </li></ul><ul><ul><li>9% adverse events, 40% related to ‘e...
A Context-aware Patient Safety System <ul><li>Context-awareness </li></ul><ul><ul><li>RFID sensor input + other input </li...
So what’s different? <ul><li>ElderTech </li></ul><ul><ul><li>Continuous Monitoring coupled with patient-clinician reliabil...
Methodology
Evidence-Based Medicine – EBM <ul><li>U.S. Preventive Services Task Force & UK National Health Service </li></ul><ul><ul><...
Proof-of-Concept <ul><li>“ The construction of working prototypes of the necessary infrastructure in sufficient quality to...
Clinical Proof-of-Concept
Clinical Proof of Concept – CPoC <ul><li>Technology </li></ul><ul><ul><li>Working prototype </li></ul></ul><ul><ul><li>Usa...
Examples of Clinical PoC <ul><li>AwareMedia </li></ul><ul><ul><li>Clinical PoC in a surgical ward  for 4-5 months </li></u...
Summing up
So – is Pervasive Healthcare new Wine?
Call for Action <ul><li>Maintain focus on “pervasive” approach to healthcare </li></ul><ul><ul><li>Supporting the move fro...
Contact details <ul><li>Jakob E. Bardram </li></ul><ul><ul><li>[email_address] </li></ul></ul><ul><ul><li>www.itu.dk/~bard...
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Is Pervasive Healthcare Old Wine on a New Bottle?

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Keynote talk given at the Pervasive Health Conference 2008 in Tampere, Finland.

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  • Is Pervasive Healthcare Old Wine on a New Bottle?

    1. 1. Is 'Pervasive Healthcare' old wine on a new bottle – or is it a real, but emerging, research discipline? Jakob E. Bardram
    2. 2.
    3. 3. The Age Tsunami US Demand/Supply of Nurses
    4. 4.
    5. 5. Source : Eric Dishman. Inventing wellness systems for aging in place, IEEE Computer 37:5 (May 2004), 34–41..
    6. 6. Changing the Centralized Model of Healthcare <ul><li>Acute -> Continuous </li></ul><ul><li>Hospitalization -> Home & out-patient </li></ul><ul><li>Reactive -> Pro-active & Preventive </li></ul><ul><li>IT -> Assistive Technology </li></ul><ul><li>Centralized -> Pervasive </li></ul><ul><li>Sampling -> Monitoring </li></ul><ul><li>Doctor-centric -> Patient-centric </li></ul>
    7. 7. Pervasive Healthcare <ul><li>Application of pervasive computing, ubiquitous computing, proactive computing, ambient intelligence technologies for healthcare, health, and wellness management. </li></ul><ul><li>Second, it is about making healthcare pervasively available everywhere, anytime, and to anyone. </li></ul><ul><li>In essence, pervasive healthcare addresses a set of related technologies and concepts that help integrate healthcare more seamlessly to our everyday lives, regardless of space and time. </li></ul>Source: Korhonen, Ilkka, and Bardram, Jakob B. Guest editorial introduction to the special section on pervasive healthcare, IEEE Transactions on Information Technology in Biomedicine 8:3, 2004, 229–234.
    8. 8. Agenda <ul><li>Historical Roots </li></ul><ul><ul><li>Biomedical Engineering, Medical Informatics, UbiComp </li></ul></ul><ul><li>Characteristics of Pervasive Healthcare </li></ul><ul><li>Research Themes </li></ul><ul><li>Examples </li></ul><ul><ul><li>Home based monitoring of vital signs </li></ul></ul><ul><ul><li>Pervasive Computing in Hospitals </li></ul></ul><ul><li>Methods </li></ul><ul><ul><li>Evidence-Based Medicine </li></ul></ul><ul><ul><li>Clinical Proof-of-Concept </li></ul></ul><ul><li>Is the wine new? </li></ul>
    9. 9.
    10. 10.
    11. 11.
    12. 12. Historical Roots
    13. 13. Biomedical Engineering – BME <ul><li>Biomedical engineering (BME) is the application of engineering principles and techniques to the medical field. </li></ul><ul><li>BME combines the design and problem solving skills of engineering with the medical and biological science to help improve patient health care and the quality of life of healthy individuals. </li></ul><ul><li>Research Areas </li></ul><ul><ul><li>Bioelectrical and neural engineering </li></ul></ul><ul><ul><li>Biomedical imaging and biomedical optics </li></ul></ul><ul><ul><li>Biomaterials </li></ul></ul><ul><ul><li>Biomechanics and biotransport </li></ul></ul><ul><ul><li>Biomedical devices and instrumentation </li></ul></ul><ul><ul><li>Molecular, cellular and tissue engineering </li></ul></ul><ul><ul><li>Systems and integrative engineering </li></ul></ul>
    14. 14. Biomedical Engineering
    15. 15. Medical Informatics – MI <ul><li>Medical informatics (MI) is the intersection of information science, computer science and health care. </li></ul><ul><li>MI deals with the resources, devices and methods required to optimize the acquisition, storage, retrieval and use of information in health and biomedicine. </li></ul><ul><li>Health informatics tools include not only computers but also </li></ul><ul><ul><li>clinical guidelines, </li></ul></ul><ul><ul><li>formal medical terminologies, and </li></ul></ul><ul><ul><li>information and communication technology(ICT) </li></ul></ul>
    16. 16. Medical Informatics <ul><li>Hospital Information Systems </li></ul><ul><li>Electronic Patient Record </li></ul><ul><ul><li>Medicine Charts </li></ul></ul><ul><ul><li>Nursing Records </li></ul></ul><ul><li>Clinical Decision Support Systems </li></ul><ul><li>Integration </li></ul><ul><li>Standards </li></ul><ul><ul><li>DICOM, HL7, </li></ul></ul><ul><li>Medical vocabularies </li></ul><ul><ul><li>SNOMED, … </li></ul></ul>
    17. 17. Ubiquitous Computing PC Mini Mobile Internet Mainframe Ubiquitous
    18. 18. Ubiquitous Computing <ul><li>Embedded / invisible / ambient computing </li></ul><ul><li>From 1:1 to N:N computing </li></ul><ul><li>Mobility and Wireless connectivity </li></ul><ul><li>Collaboration </li></ul><ul><li>Sensor networks </li></ul><ul><li>Context-aware Computing </li></ul><ul><li>Capture and Access </li></ul><ul><li>From “computer” to “tool” </li></ul>
    19. 19. Pervasive Healthcare – Characteristics <ul><li>Technology </li></ul><ul><ul><li>Sensor technology and networks </li></ul></ul><ul><ul><li>Embedded and mobile devices </li></ul></ul><ul><ul><li>Context-aware adaptation </li></ul></ul><ul><ul><li>Capture & Access </li></ul></ul><ul><li>Clinical approach </li></ul><ul><ul><li>Pro-active and preventive </li></ul></ul><ul><ul><li>Patient-focused </li></ul></ul><ul><ul><li>Monitoring rather that sampling </li></ul></ul><ul><ul><li>Assistive Technology rather than Information Technology </li></ul></ul><ul><li>Research </li></ul><ul><ul><li>Multi-disciplinary – from field studies to hardware design </li></ul></ul><ul><ul><li>Proof-of-Concept – rather than evidence-based medicine </li></ul></ul>
    20. 20. Pervasive Healthcare – Research Themes <ul><li>Monitoring </li></ul><ul><li>Assistive Technologies </li></ul><ul><li>Preventive and pro-active health systems </li></ul><ul><li>Self-care & Self-treatment </li></ul><ul><li>Medication support and compliance </li></ul><ul><li>Capture and Access, Training </li></ul><ul><li>Clinical Support Systems </li></ul><ul><li>Software Architecture </li></ul><ul><li>Sensor and Network Design </li></ul><ul><li>Field Studies </li></ul><ul><li>Persuasive technologies for better health </li></ul><ul><li>… </li></ul>
    21. 21. Medication I
    22. 22. Medication II
    23. 23. Telemedicine?
    24. 24. Pervasive Monitoring Wireless Monitors Bodyworn Monitors Mobile Monitoring Body Sensor Network MyHeart Project
    25. 25. Challenges in Monitoring <ul><li>Robust measurement and processing methods requires access to large and representative real data sets </li></ul><ul><ul><li>Real cases in real environment with real problems and artifacts </li></ul></ul><ul><ul><li>Reference data - real well-being - collected in parallel </li></ul></ul><ul><ul><li>Similar problem when collecting evidence for correct functioning and usefulness of the method - required for evidence based medicine (EBM) </li></ul></ul><ul><li>How to reach this - especially for long term (months - years)? </li></ul><ul><ul><li>Motivation of (many enough real) subjects to wear/use often bulky and error-prone prototypes </li></ul></ul><ul><ul><li>Ethics? </li></ul></ul><ul><ul><li>Practical and economical issues: prototype costs (many copies needed), maintenance costs (battery replacements, data transfer, calibration, etc.) </li></ul></ul><ul><li>Result: few success stories so far… </li></ul>Source : Ilkka Korhonen
    26. 26. Example I ElderTech – Technologies for Elders
    27. 27. <ul><li>Purpose </li></ul><ul><ul><li>Self-care and independent living </li></ul></ul><ul><ul><li>Easy communication with clinical staff, relatives and peers </li></ul></ul><ul><ul><li>Continuous updated view on health status </li></ul></ul><ul><ul><li>Basis for pro-active clinical contingency management </li></ul></ul><ul><ul><li>Shared care – cooperation across clinical boundaries </li></ul></ul><ul><li>Features </li></ul><ul><ul><li>Monitoring – Blood Pressure and Weight (wireless) </li></ul></ul><ul><ul><li>Medication – administration and management </li></ul></ul><ul><ul><li>Communication & Coordination – “The Collaboration Book” </li></ul></ul><ul><li>Deployment </li></ul><ul><ul><li>7 Homes, elders 70+ </li></ul></ul><ul><ul><li>Nursing staff, nurses and assistants </li></ul></ul><ul><ul><li>~3 months </li></ul></ul><ul><ul><li>Qualitative data collection </li></ul></ul>
    28. 28. Technical Setup
    29. 29.
    30. 30.
    31. 31.
    32. 32.
    33. 33.
    34. 34.
    35. 35.
    36. 36.
    37. 37.
    38. 38.
    39. 39.
    40. 40. Findings – Elders <ul><li>Usability </li></ul><ul><ul><li>Scale & BP monitor used frequently </li></ul></ul><ul><ul><li>The PC – 5 out of 7 did not use it </li></ul></ul><ul><li>Communication </li></ul><ul><ul><li>No changes experienced </li></ul></ul><ul><ul><li>But was not looking into the ‘collaboration book’ </li></ul></ul><ul><li>Clinically, Self-care, Monitoring </li></ul><ul><ul><li>Liked the monitoring </li></ul></ul><ul><ul><li>Increased their feeling of security/safety </li></ul></ul><ul><ul><li>Was trusting the staff to monitor their health data and react if necessary </li></ul></ul><ul><ul><li>Documentation of medicine intake was not considered relevant </li></ul></ul>
    41. 41.
    42. 42. Findings – Healthcare Workers <ul><li>Administration </li></ul><ul><ul><li>Collaboration book </li></ul></ul><ul><ul><li>Integration with care system </li></ul></ul><ul><li>Communication </li></ul><ul><ul><li>Might improve communication with GP </li></ul></ul><ul><li>Clinically </li></ul><ul><ul><li>Felt uncomfortable – Responsibility of the GP </li></ul></ul><ul><ul><li>Extra work – felt not necessary </li></ul></ul><ul><li>Remote monitoring and prevention </li></ul><ul><ul><li>Indications </li></ul></ul><ul><ul><li>Specific groups of elders – diabetics, hypertension, … </li></ul></ul><ul><ul><li>Concerned about remote monitoring – “not the right picture” </li></ul></ul>
    43. 43. Lessons learned about designing AT <ul><li>Vital sign monitoring is ‘interesting’ </li></ul><ul><ul><li>but introduces a huge responsibility for actually reading them </li></ul></ul><ul><li>Communication and sharing seems to be just as interesting </li></ul><ul><ul><li>between nurses/GP/hospital </li></ul></ul><ul><ul><li>between clinicians and citizens </li></ul></ul><ul><ul><li>between citizens </li></ul></ul><ul><li>If “Information Technology” is part of the solution </li></ul><ul><ul><li>then IT has to look considerable different that it does now! </li></ul></ul><ul><li>Experimentation is essential in the design process </li></ul><ul><ul><li>we actually do not know what we do </li></ul></ul><ul><ul><li>… what will work </li></ul></ul><ul><ul><li>… how to design it </li></ul></ul><ul><ul><li>… and how users will use it </li></ul></ul><ul><ul><li>hence, close-loop experimentation is essential </li></ul></ul>
    44. 44. Example II The Interactive Hospital – Supporting Awareness in a Operating Ward
    45. 45. Whiteboards in Hospitals Source : J.E. Bardram, Temporal Coordination - On Time and Coordination of Collaborative Activities at a Surgical Department. Computer Supported Cooperative Work , 9(2):157-187, 2000.
    46. 46.
    47. 47. Affordances of Whiteboards <ul><li>Core Roles of Whiteboards in Hospitals </li></ul><ul><ul><li>Visibility </li></ul></ul><ul><ul><li>Overview </li></ul></ul><ul><ul><li>Status </li></ul></ul><ul><ul><li>Coordination </li></ul></ul><ul><ul><li>Communication </li></ul></ul><ul><ul><li>Handling contingencies </li></ul></ul><ul><li>Research </li></ul><ul><ul><li>Temporal Coordination [Bardram, JCSCW 2000] </li></ul></ul><ul><ul><li>Cog. Props of Whiteboards [Xiao et al, ECSCW 2001] </li></ul></ul><ul><ul><li>Inf. & Repres. [Reddy et al., ECSCW 2001] </li></ul></ul><ul><ul><li>Web of Artifacts [Bardram & Bossen, GROUP 2005] </li></ul></ul>
    48. 48. Design of AwareMedia <ul><li>” Putting the schedule back on the wall” </li></ul><ul><ul><li>Public and shared social awareness </li></ul></ul><ul><ul><li>Temporal awareness </li></ul></ul><ul><ul><li>Spatial awareness </li></ul></ul><ul><ul><li>Communication </li></ul></ul>Source : J.E. Bardram, T.R. Hansen and M. Soegaard. AwareMedia: a shared interactive display supporting social, temporal, and spatial awareness in surgery. In Proceedings of ACM CSCW '06 , p. 109-118, ACM Press, 2006.
    49. 49. AwareMedia User Interface
    50. 50. AwareMedia Technology & Architecture <ul><li>Technologies </li></ul><ul><ul><li>Media Spaces </li></ul></ul><ul><ul><li>Scheduling/Booking </li></ul></ul><ul><ul><li>Context-awareness </li></ul></ul><ul><ul><li>Instant Messaging </li></ul></ul><ul><li>Builds upon </li></ul><ul><ul><li>AWARE architecture </li></ul></ul><ul><ul><ul><li>[CSCW 2004] </li></ul></ul></ul><ul><ul><li>JCAF framework </li></ul></ul><ul><ul><ul><li>[Pervasive 2005] </li></ul></ul></ul>
    51. 51. 1. Spatial Awareness <ul><li>OR Space </li></ul><ul><ul><li>Video </li></ul></ul><ul><ul><li>Status </li></ul></ul><ul><ul><li>People in the OR </li></ul></ul><ul><ul><li>Patient </li></ul></ul><ul><ul><li>Type of surgery & expected end time </li></ul></ul>
    52. 52. 2. Temporal Awareness <ul><li>OR Schedule </li></ul><ul><ul><li>Operations </li></ul></ul><ul><ul><li>OR Teams </li></ul></ul><ul><ul><li>Timing </li></ul></ul><ul><ul><li>Delays </li></ul></ul><ul><ul><li>Cancellations </li></ul></ul>
    53. 53. 3. Social Awareness <ul><li>Context </li></ul><ul><ul><li>Picture, Name & Initials </li></ul></ul><ul><ul><li>Location </li></ul></ul><ul><ul><li>Activity (e.g. surgery) </li></ul></ul><ul><ul><li>Tracking device </li></ul></ul><ul><ul><li>Role (e.g. replacement, coodinator, surgeon) </li></ul></ul>
    54. 54. Deployment <ul><li>Site </li></ul><ul><ul><li>OR Ward, Bed Ward, Recovery </li></ul></ul><ul><ul><li>Supports 3 ORs, 30-50 people pr. day </li></ul></ul><ul><li>Technology </li></ul><ul><ul><li>Coordination central -> 2 large interactive displays </li></ul></ul><ul><ul><li>3 OR / Wards -> 20’’ touch screens </li></ul></ul><ul><ul><li>Web cams </li></ul></ul><ul><ul><li>Location tracking based on Bluetooth </li></ul></ul><ul><ul><ul><li>Tag </li></ul></ul></ul><ul><ul><ul><li>Mobile phones </li></ul></ul></ul><ul><ul><li>~20 AwarePhones </li></ul></ul><ul><li>Deployed during 12 months </li></ul>
    55. 55. Hospital
    56. 56. Operating Ward
    57. 57.
    58. 58.
    59. 59.
    60. 60. AwareMedia in Use <ul><li>Data collection </li></ul><ul><ul><li>Observations, Interviews, Data Logging </li></ul></ul><ul><li>Lessons learned </li></ul><ul><ul><li>Increase Awareness and Communication </li></ul></ul><ul><ul><ul><li>More efficiency in OR coordination </li></ul></ul></ul><ul><ul><ul><li>Fewer interruptions </li></ul></ul></ul><ul><ul><li>Redundant information </li></ul></ul><ul><ul><ul><li>Location, status, operations, … </li></ul></ul></ul><ul><ul><li>Simple, stable, and predictable displays </li></ul></ul><ul><ul><ul><li>Easy to learn, use, and navigate in a critical environment </li></ul></ul></ul>
    61. 61. Example III Context-aware Patient Safety in the Operating Room
    62. 62. Patient Safety <ul><li>Institute of Medicine: “To err is Human” </li></ul><ul><ul><li>9% adverse events, 40% related to ‘errors’, 60% to complications </li></ul></ul><ul><ul><li>Danish studies confirm this </li></ul></ul><ul><li>Utah and Colorado </li></ul><ul><ul><li>Operative adverse events comprised 44.9% of all adverse events </li></ul></ul><ul><li>Joint Commission </li></ul><ul><ul><li>Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery </li></ul></ul><ul><li>Danish Recommendation </li></ul><ul><ul><li>Improve communication and coordination </li></ul></ul><ul><ul><li>Improve patient identification </li></ul></ul><ul><ul><li>… </li></ul></ul><ul><li>Source : </li></ul><ul><li>Institute of Medicine </li></ul><ul><li>E J Thomas et al (2000). Incidence and types of adverse events and negligent care in Utah and Colorado. Med. Care., vol. 38, no. 3. </li></ul>
    63. 63.
    64. 64. A Context-aware Patient Safety System <ul><li>Context-awareness </li></ul><ul><ul><li>RFID sensor input + other input </li></ul></ul><ul><ul><li>Based on the Java Context-Awareness Framework (JCAF) </li></ul></ul><ul><ul><li>Extended with reasoning engine (JESS) </li></ul></ul><ul><li>Features </li></ul><ul><ul><li>Presenting relevant information during operation </li></ul></ul><ul><ul><ul><li>PACS, EPR, Operation data </li></ul></ul></ul><ul><ul><li>Monitors progress and fire warnings </li></ul></ul><ul><ul><ul><li>Patient, Team, Blood, Patient Status, Equipment, … </li></ul></ul></ul><ul><li>Clinical Proof-of-Concept </li></ul><ul><ul><li>Full functioning prototype </li></ul></ul><ul><ul><li>Deployed inside one OR with a full OR team </li></ul></ul><ul><ul><li>Used during one day (no real patients, however) </li></ul></ul><ul><ul><li>Qualitative evaluation </li></ul></ul>
    65. 65.
    66. 66.
    67. 67.
    68. 68.
    69. 69. So what’s different? <ul><li>ElderTech </li></ul><ul><ul><li>Continuous Monitoring coupled with patient-clinician reliability and trust </li></ul></ul><ul><ul><li>Focus on Patient communication – not telemedicine </li></ul></ul><ul><ul><li>Methods are not clinically oriented </li></ul></ul><ul><li>The Interactive Hospital </li></ul><ul><ul><li>Social and Context Awareness </li></ul></ul><ul><ul><li>Focus on clinical collaboration and usability – not health informatics </li></ul></ul><ul><li>Patient Safety in the OR </li></ul><ul><ul><li>Context awareness and reasoning </li></ul></ul><ul><ul><li>Focus on ‘contextual’ and ‘procedural’ safety – not biological safety </li></ul></ul>
    70. 70. Methodology
    71. 71. Evidence-Based Medicine – EBM <ul><li>U.S. Preventive Services Task Force & UK National Health Service </li></ul><ul><ul><li>Level I: Evidence obtained from at least one properly designed randomized controlled trial . </li></ul></ul><ul><ul><li>Level II-1: Evidence obtained from well-designed controlled trials without randomization . </li></ul></ul><ul><ul><li>Level II-2: Evidence obtained from well-designed cohort or case-control analytic studies , preferably from more than one center or research group. </li></ul></ul><ul><ul><li>Level II-3: Evidence obtained from multiple time series with or without the intervention . Dramatic results in uncontrolled trials might also be regarded as this type of evidence. </li></ul></ul><ul><ul><li>Level III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees. </li></ul></ul>Source : Wikipedia U.S. Preventive Services Task Force & UK National Health Service
    72. 72. Proof-of-Concept <ul><li>“ The construction of working prototypes of the necessary infrastructure in sufficient quality to debug the viability of the system in daily use; ourselves and a few colleagues serving as guinea pigs” </li></ul>Source : Marc Weiser. “Some Computer Science Issues in Ubiquitous Computing”, in Communications of the ACM , 36(7), 1993, ACM.
    73. 73. Clinical Proof-of-Concept
    74. 74. Clinical Proof of Concept – CPoC <ul><li>Technology </li></ul><ul><ul><li>Working prototype </li></ul></ul><ul><ul><li>Usable (but not necessarily user-friendly) </li></ul></ul><ul><ul><li>Stand alone </li></ul></ul><ul><ul><li>Focused on specific research questions </li></ul></ul><ul><li>Deployment </li></ul><ul><ul><li>Deployment in a real clinical environment </li></ul></ul><ul><ul><li>Used by real users (researchers are hands-off) </li></ul></ul><ul><ul><li>For a short , but sufficient time of period (1 day – 3 months) </li></ul></ul><ul><li>Collecting ‘Evidence’ </li></ul><ul><ul><li>Observations </li></ul></ul><ul><ul><li>Questionnaires </li></ul></ul><ul><ul><li>Perceived Usefulness and Usability </li></ul></ul><ul><ul><li>Measure – if possible </li></ul></ul>Qualitative data Quantitative data
    75. 75. Examples of Clinical PoC <ul><li>AwareMedia </li></ul><ul><ul><li>Clinical PoC in a surgical ward for 4-5 months </li></ul></ul><ul><li>Patient Safety </li></ul><ul><ul><li>Clinical PoC in an OR during 1 day </li></ul></ul><ul><li>Home based monitoring </li></ul><ul><ul><li>Clinical PoC during ~3 months in 7 homes </li></ul></ul>
    76. 76. Summing up
    77. 77. So – is Pervasive Healthcare new Wine?
    78. 78. Call for Action <ul><li>Maintain focus on “pervasive” approach to healthcare </li></ul><ul><ul><li>Supporting the move from a Mainframe to a Pervasive model of healthcare </li></ul></ul><ul><li>Define and describe Pervasive Healthcare </li></ul><ul><ul><li>Post it to Wikipedia </li></ul></ul><ul><ul><li>International Association of Pervasive Healthcare – IAPHC? </li></ul></ul><ul><li>Define the research methods for Pervasive Healthcare </li></ul><ul><ul><li>“ Moving out of the lab” </li></ul></ul><ul><ul><li>Clinical Proof-of-Concept </li></ul></ul><ul><li>Ensure research quality </li></ul><ul><ul><li>Do not be an isolated group of researchers </li></ul></ul><ul><ul><li>Make profound research which can be published in well-established venues and journals </li></ul></ul><ul><ul><li>Ensure affiliation with IEEE and ACM </li></ul></ul>
    79. 79.
    80. 80.
    81. 81.
    82. 82.
    83. 83. Contact details <ul><li>Jakob E. Bardram </li></ul><ul><ul><li>[email_address] </li></ul></ul><ul><ul><li>www.itu.dk/~bardram </li></ul></ul>

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