Pervasive Computing

1. Pervasive Healthcare and Wireless
Health Monitoring
Upkar 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 Monitoring
Upkar Varshney

Overview
Introduction
Pervasive 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
COMPREHENSIVEHEALTH
MONITORING
VITALSIGNS&
DIGITIZATION

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
Introduction
Case 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.

Pervasive Computing

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (20)

Similar to Pervasive Computing

Similar to Pervasive Computing (20)

More from Asli Yazagan

More from Asli Yazagan (8)

Recently uploaded

Recently uploaded (20)

Pervasive Computing