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UbiHealth 2004: The 3rd International Workshop
on Ubiquitous Computing for Pervasive
Healthcare Applications

Tim Adlam

Bath Institute of Medical Engineering, University of Bath, UK.

Howard Wactlar

School of Computer Science, Carnegie Mellon University, Pittsburgh, PA, USA 15213

Ilkka Korhonen

VTT Information Technology, P.O.Box 1206 (Sinitaival 6), FIN-33101 Tampere, FINLAND

1  Introduction

The aim of pervasive care is to deliver continuous, appropriate and effective aids so that the recipient is provided with an improved quality of life. If these aids are used by the care provider, the goal is further to deliver that care more efficiently, less stressfully, and always with compassion.
Pervasive health and social care can be defined as:
  1. The application of pervasive and ubiquitous computing technologies to the health and social care of people in diverse environments.
  2. Making effective care available to people in diverse environments while improving quality of life without disruption to daily living.
Pervasive computing is aiming to build technology into the lives of people that will enhance quality of life and integrate into normal modes of behaviour. Pervasive care has similar aims, but is specifically directed towards meeting the needs that are related to the wellbeing and independence of the user.
There is much technology being developed in the laboratory that will potentially be beneficial to many users. However, how should this technology be developed and evaluated by end users - how are they to inform the designer of their needs and preferences? What protocols should be followed when introducing developing technology to users, who, perhaps have a cognitive disability? What ethical frameworks and protocols should be constructed to protect vulnerable users from abuse by researchers?
Previous UbiCog and UbiHealth workshops (at UbiComp 2002 and 2003) have explored pervasive healthcare technologies, their design and application. It is now appropriate to explore not only emerging technologies, but also how these technologies should be configured for and delivered to their end users. Is the existing organisational infrastructure adequate for the consistent, supported and appropriate delivery of pervasive healthcare systems to the end user; whether that user is a consultant in a hospital or an older person with dementia living alone at home?
How should technologies be developed and evaluated in context? The processes required for the effective design and evaluation of interfaces and systems to support sick and disabled people are not the same as those used in conventional engineering design. This is especially true when designing for people with cognitive disabilities.

2  Proposed Themes

The workshop will examine several specific themes. These are described below.

2.1  Ethics

As ubiquitous health and social care is moving out of the laboratory and into the field, so an ethical framework is being developed to govern the practice of research and evaluation; and later assessment, supply, installation and support by public and private health and social care agencies. Some researchers are already developing frameworks for projects, for example the European ENABLE 1 project, which has been evaluating systems for people with dementia in their own homes. This work has raised fundamental questions such as "how can a person with dementia give informed consent to an evaluation?". This question may be one of many that require careful and lucid consideration by a research team before they embark on in-context evaluation.
What existing ethical frameworks are appropriate to such work and how does their application affect the methods currently used by researchers in the field? How can researchers design appropriate ethical procedures for the evaluation of equipment by people with cognitive disabilities?

2.2  In Context Evaluation

For a pervasive computing system to be useful to its intended end users, it should be evaluated by its end users during its development. This is especially true for systems that are to be used by people with disabilities. Designers who are not disabled cannot understand a disability to the extent that they can project themselves into the subjective world of a disabled person. It is essential that disabled users themselves are able to evaluate devices and influence their design throughout the design process, and not just at the initial or final stages.
Such evaluation work is challenging with people who have physical disabilities. Evaluation is even harder with people with cognitive disabilities that make obtaining reasoned and structured assessments of equipment difficult. In such a context good interpersonal skills become essential. Protocols and methods for the evaluation of devices by people with cognitive disabilities are being developed, but remain few in number.
How can devices and systems be evaluated by people with physical and cognitive disabilities in such a way that their evaluation is useful for the direction of further development, and for the validation of existing development?

2.3  Service Delivery

The development of new pervasive systems for health and social care continues to yield new technologies and new applications of existing technologies. At present very few of these technologies have been implemented on a large scale. Generally, the organisational infrastructure to install and support these technologies is not in place. In many cases widespread implementation may require the training of a new breed of technically competent and person-aware installers who have the interpersonal skills to be able to install complex systems in the homes of people with complex mental and physical disabilities.
How will these technologies be delivered to their end users? What organisational infrastructure will be required for assessment, installation and support? Can pervasive healthcare technology make it to the diverse shelves of the shopping mall?
The workshop will seek to identify routes to delivery and the organisational infrastructure required for effective sustainable implementation.

2.4  New Technologies and Applications

Though not driven by them, new technologies such as wireless networks, sensor networks, small low-power microcomputers, gesture recognition and wearable systems are making pervasive health and social care possible. It is important for participants to become aware of new technologies that are emerging, available and being applied in the field. We wish to facilitate collaboration between researchers developing similar technologies; inform them of developments outside their immediate field that may be relevant to their own work.

2.4.1  Hospitals

A hospital is a complex environment that continuously generates a huge quantity of data. Hospitals are beginning to implement electronic patient records so that this data is more manageable and accessible. However it is still commonly restricted to hospital network access points. Research is being conducted to develop pervasive information systems that can make such information available to practitioners anywhere in the hospital. How should such personally sensitive data be managed in a pervasive computing environment? What type of mobile devices will be appropriate for displaying text based patient records and detailed medical images?

2.4.2  Community Care

Healthcare in the developed world is moving from the institution into the home - the reverse of what is happening in developing countries. Primary care and the general practitioner have long been the point of access to further medical services and the point of delivery for basic healthcare. People are being moved from long term care institutions back into the community, or their admission into an institution is delayed.
Two factors are driving these changes: the cost of institutional care and an acknowledgment that quality of life can be improved by living at home with care provided in situ. As this shift in focus occurs, pervasive health care technology is making patient information available to mobile practitioners and collecting information from patients at home. It is also providing care for people at home: intervening in dangerous situations, alerting remote carers to nascent problems, and extending the time that people are able to stay at home before it is necessary to move into residential care. How can people be effectively supported at home with care and dignity? How can relevant information be collected, processed and made available to mobile caregivers?

2.4.3  Residential Care

When it is no longer possible for a person to be cared for in the community, they are usually moved to a residential care facility. This may be sheltered, very sheltered, or nursing care. The level of support provided by such facilities varies, but in all cases help is available to residents 24 hours per day. In this context pervasive computing technology may be monitoring the wellbeing of residents, alerting staff when human intervention is required, and employing safety systems to prevent incidents such as bathroom flooding and kitchen fires. What technology can be integrated into residential buildings to increase the safety and quality of life of the residents? How is this technology best presented to the user?

2.4.4  Wellness, Fitness and Preventative Care

Not all potential users of pervasive healthcare technology will be sick or disabled. The technology can also be applied to help prevent disease, and maintain health and fitness. Wearable devices that monitor critical indicators of wellbeing can give advanced warning of potential problems. They can encourage users to participate in exercise and monitor their participation, or provide health information to a shopper in a food store.
Many of these applications require the gathering of information over long periods of time. Where should this information be stored? Who should have control of it and access to it? The benefits of maintaining a healthy lifestyle are great, but how should this technology be delivered to the older part of the population who stand to reap the greatest benefit?

3  Activities

It is proposed that the workshop be held over two days with an optional first day consisting of a visit to the Gloucester Smart House for people with dementia. The second day will include presentations, a speaker and a panel discussion.

3.1  A Visit to the Gloucester Smart House

It is proposed to make a visit to a UK smart house designed for people with dementia. The Gloucester Smart House has been developing since 1999. Though not highly automated, the house demonstrates the application of ubiquitous computing technology to the care of people with dementia through the use of supportive devices integrated into the fabric of a house in a very unobtrusive way. Devices showcased in the house have been installed in the homes of people with dementia as part of the ENABLE evaluation project.

3.2  Presentations

For the morning sessions, presentations of position papers will be invited from practitioners and researchers in pervasive health and social care technology. It is the aim of the presentations to set out the current state of pervasive healthcare technology, its application, and delivery to its end users. Papers will be judged on their pertinence to the themes of the workshop, their relevance to the delegates, and their scientific merit.

3.3  Speaker

The organisers will invite a medical ethicist to speak at the workshop for the purpose of outlining the ethical issues faced by researchers working with unproven technology given to disabled people in their own homes. Clear thinking about such issues is important before evaluations are begun.

3.4  Panel Discussion

Following the speaker, there will be a discussion of issues raised during the morning presentations and by the speaker. The panel will be composed of the speaker and selected delegates who have experience of different aspects of the application of pervasive healthcare technology in hospital, community and residential contexts.

4  Goals

UbiHealth 2004 has three goals.
  1. The development of collaboration between researchers into pervasive healthcare technologies, industry and healthcare providers with the aim of encouraging the vertical integration of research and application across disciplinary boundaries. Partnerships between healthcare providers, industry and researchers will provide the best means of delivery of technologies that are currently in the research lab.
  2. The exploration of future directions of research into the development of new technologies for healthcare and the application of existing technologies in the field.
  3. The dissemination of research to participants with the aim of improving awareness of applicable technologies, infrastructures and ethical concerns.

5  Participation

Participants are welcome from industry, academia and government. We encourage participation and submissions from people who are designing, evaluating, implementing, installing and supporting pervasive health and social care technologies in contexts such as hospitals, residential care homes, people's own homes and out-patient care.
No more than 15 position papers will be accepted for presentation.

6  Publicity and Dissemination

The workshop will be publicised through a website hosted by the organisers with a link from the UbiComp website and departmental websites (both to be confirmed); and through emails to previous UbiHealth delegates and their departments. UbiHealth 2003 was attended by approximately 50 delegates with 26 papers submitted.
Accepted papers will be published on the workshop website. The organising committee is considering arranging publication of the proceedings of the workshop by the University of Aarhus, if sufficient papers are submitted to justify printing.

7  Organisers

The workshop organisers are from diverse backgrounds including universities, hospitals and commercial companies. They have wide ranging experience in pervasive healthcare including the design, development, evaluation, implementation and support of pervasive healthcare technologies.

7.1  Chair

*  Tim Adlam, Bath Institute of Medical Engineering
Tim joined the Bath Institute of Medical Engineering in 1996 after graduating with an MSc in Biomedical Engineering. He has been developing smart house systems for people with dementia since the inception of the UK EPSRC 2 supported Gloucester Smart House project in 1999. These systems have interfaces that are accessible to people with dementia without requiring learning. Examples include bath and cooker monitors and a novel sensor for detecting bed occupancy. The European ENABLE project has provided him with experience of installing and supporting systems for people with dementia in their own homes in three European countries. His work has been presented and published in the UK, Europe and the USA. His current research interests include investigating effective means of communication from machines to people with dementia, the design of external fracture fixators, and the design of tools for daily living. Tim is a chartered mechanical engineer. [www.bime.org.uk]

7.2  Co-Chair

*  Howard Wactlar, Carnegie Mellon University Howard is Vice Provost for Research Computing, Associate Dean, and Alumni Research Professor in the School of Computer Science, Carnegie Mellon University, USA. He is project director of the Informedia Digital Video Library and is the principal investigator for the NSF-funded Digital Human Memory Machine and CareMedia projects. The latter collects a continuous video and audio record of activity in skilled nursing care facilities, and through automated information extraction and behavior analysis transforms it into an information resource that provides geriatric care specialists with greater insights into problems, effectiveness of treatments, and determination of environmental and social influences on patient behavior. His current research centers on multimedia information systems, machine learning and intelligent systems, and their application to improving health care.

7.3  Editors

*  Ilkka Korhonen, VTT Technology Prof. Ilkka Korhonen's main research interests are the application of pervasive computing on healthcare and wellness, biosignal interpretation, home and wearable health monitoring, and critical care patient monitoring. He received his PhD ('97) in signal processing from Tampere University of Technology, Finland. He is a docent in Medical Informatics at Tampere University of Technology, and a Research Professor in Intuitive Information Technology at VTT Information Technology, Tampere, Finland. He has more than 80 scientific publications in international scientific journals and conferences.[www.vtt.fi/tte/research/tte5/]
*  Katie Moor, Indiana University Katie is a PhD candidate in Computer Science at Indiana University working with Kay Connelly in the Security for Ubiquitous Resources Group (SURG). She is currently working with nurses, dieticians, and nephrologists at Indiana University Hospital to create a proof-of-concept personal digital assistant application for dialysis patients to monitor fluid and sodium intake. Katie is interested in integrating ubiquitous computing in health care environments to improve patient quality of life. Katie has been on the Program Committee for conferences in the United States.
*  Alex Mihailidis, University of Toronto Dr. Mihailidis has been conducting research in the area of cognitive devices for older adults with dementia for the past nine years. While at Sunnybrook & Women’s College Health Sciences Centre in Toronto, Canada, he was one of the first researchers in this field to develop and clinically test a prototype of an intelligent cognitive device that assisted older adults with Alzheimer’s disease during a washroom task. He has presented this area of work at many international conferences and has published in key journals related to rehabilitation engineering, assistive devices, and dementia care.

7.4  Publicity and Dissemination

*  Jakob E. Bardram, University of Aarhus Dr. Bardram's main research areas are pervasive and ubiquitous computing, distributed component based systems, computer supported cooperative work (CSCW), human-computer interaction (HCI), and medical informatics. His main focus currently is 'Pervasive Healthcare' and is conducting research into technologies of future health - both at hospitals and in the patient's home. Currently, he is managing a large project investigating technologies for "The Future Hospital". He received his Ph.D. in computer science in 1998 from the University of Aarhus, Denmark. He currently directs the Centre for Pervasive Healthcare at Aarhus University [www.pervasivehealthcare.dk].

8  Additional Authors

*  Alex Mihailidis: University of Toronto
*  Katie Moor: Indiana University
*  Jakob Bardram: University of Aarhus

Footnotes:

1The ENABLE project evaluated devices for people with dementia in five countries using a quality of life scale. [www.enableproject.org]
2EPSRC: The UK Government funded Engineering and Physical Sciences Research Council