Design and Implementation of A Virtual Assistant for Healthcare Professionals Using Pervasive Computing Technologies*
Sheikh I. Ahamed, Moushumi Sharmin,Shameem Ahmed, and Munirul M. Haque
Marquette University, Milwaukee, Wisconsin, USA
{iq, msharmin, sahmed02, and mhaque}@mscs.mu.edu / Ahmed J KhanAssistant Professor of Medicine
Medical College of Wisconsin, Milwaukee, Wisconsin, USA
Abstract
With the advancement of hand held devices, wireless and sensor network pervasive computing has achieved a perfect momentum. Formerly, a requirement existed that was a serious impediment and threat to the mobility of users -- the necessary presence of a fixed wired network. This has been resolved by the recent advances in wireless and mobile technologies, particularly Bluetooth and WiFi. The advancement of available, portable, low cost mobile devices (PDAs, cell phones, etc.) has resulted in the user’s mobility at unprecedented levels. As these devices can communicate with one another, the combined capabilities can be leveraged to form a useful new set of tools. Presently, pervasive computing is being extended into the sophisticated healthcare sector with the promise of providing an easier and more efficient mode of communication between physicians and patients or between the physicians themselves.. In this paper we provide the details of our application ‘Healthcare Aide’, which has been designed to provide not only more convenience for doctor-doctor, resident doctor-doctor, patient-doctor and nurse-doctor interaction but also a smooth pathway for real-time decision making. Our pervasive middleware MARKS (Middleware Adaptability for Resource Discovery, Knowledge Usability and Self-healing) provides the underlying support for this application in a completely transparent manner. In this paper, we have also presented our survey results from users’ point view along with performance analysis.
Keywords: Virtual Assistant, Healthcare Aide, Pervasive healthcare, and MARKS
1. Introduction
Pervasive computing [18] is the concept that incorporates computing in our working and living environment in such a way that the interaction between humans and computers becomes extremely natural, and the user can get many types of data in a totally transparent manner. Considering virtual reality, which builds an artificial world in the computer, at one end of the spectrum, we can put pervasive computing, which embeds computing in the real world at the other. Along with the forward march of wireless and sensor networks, the demand curve has increased for PDAs, mobiles, smart phones, and other small hand-held devices, to reach exponential growth. With that, pervasive computing is showing its potential in almost every aspect of our life including hospital, emergency and critical situations, industry, education, and hostile battle fields, to name a few. The use of this technology in the field of health has been termed pervasive health care. The goal of pervasive health care is to provide healthcare services to everyone at any time overcoming the constraints of place, time and availability of doctors, nurses and resident doctors.
Healthcare professionals need information delivery tools for accessing information at the point of patient care as well as transporting the information to other relevant sites. Personal digital assistants (PDAs), or hand-held devices demonstrate great promise as point of care information devices. A 1995 study on the use of PDAs at the point of care found that hardware constraints, such as memory capability limited their usefulness [28]. Since this study was completed, over the last 10 years, hand-held computer technology has advanced rapidly, and as of 2001 and 2002, between 26 and 50% of physicians used PDAs [29]. ACP-ASIM survey finds nearly half of U.S. members use hand-held computers [30]. This use appears higher among residents, with one recent study finding that over two-thirds of family practice residencies use hand-held computers in their training programs [31]. Results of another survey and follow-up interviews on 88 residents in seven programs showed most residents use PDAs daily, regardless of practice or whether their program encourages PDAs. Uses include commercial medical references and personal organization software, such as calendars and address books. The results of this study suggests improvement needed in (a) providing secure clinical data for the current patients of a given resident, and (b) allaying concerns of catastrophic data loss from their PDAs (e.g. by educating residents about procedures to recover information from PDA backup files) [32]. However, Handheld personal digital assistants (PDAs) have undergone continuous and substantial improvements in hardware and graphics capabilities, making them a compelling platform for novel developments in high space occupying usage including even teleradiology. The latest PDAs have processor speeds of up to 400 MHz and storage capacities of up to 80 Gbytes with memory expansion methods. A recent paper by the department of emergency medicine at University of Alberta, Canada shows that availability of bedside computer facility helped physicians to access information at the bedside and increased the use of Clinical Practice Guidelines Decision Support Tools. The patients also appeared to accept their use of information technology to assist in decision making [33]. Inpatient healthcare delivery involves complex processes that require interdisciplinary teamwork and frequent communication among physicians, nurses, unit secretaries, and ancillary staff. Often, these interactions are not at a nursing unit, or near a phone. A study was conducted at the St. Agnes Hospital in Baltimore, MD regarding any potential benefit of wireless communication devices. The results identified a number of significant findings that demonstrate a healthcare benefit from a quantitative and qualitative standpoint [34].
There are a number of research projects [3-14] at various universities and research institutes related to pervasive healthcare. In the CodeBlue project [12] at Harvard University, the researchers tried to provide an ad-hoc wireless infrastructure as a solution to a medical emergency situation. Using low power sensors (for providing vital data) and PDAs this project will assist the team of clinicians involved in the management of the emergency to communicate and share data more efficiently and also help in decisions making. In the WWM (Wireless Wellness Monitoring) project [3] a behavioral feedback system was implemented using some monitors, PDAs and a home server forming a WLAN (Wireless Local Area Network). In the CASCOM project [4], researchers tried to provide real-time solutions in the tele-medicine sector using mobile devices. Several application projects, working to satisfy various concerns or segments of the healthcare sector, are going on in Denmark’s ‘Centre for Pervasive Health Care’ [5].
In teleradiology a new technology has emerged to interface Picture archiving and communication systems (PACS) and PDA. PDA-based teleradiology has the potential to increase the efficiency of the radiologic work flow, increasing productivity and improving communication with referring physicians and patients [35]. For its new acute care hospital, the University of California at Los Angeles is evaluating innovative technology involving high-resolution flat panel display devices configured as "network appliances" that can be wall mounted for use in the retrieval and display of medical images and data. Physicians and healthcare providers can log on with wireless handheld computers, which can serve as an identification device as well as a navigational tool for selecting patient records and data. These data are displayed and manipulated on the flat panel display without the need for a keyboard or mouse. A prototype was developed with commercially available image display software, which was modified to allow the remote control of software functions from a handheld device through an infrared communication port. The system also allows navigation through the patient data in a World Wide Web-based electronic patient record. This prototype illustrates the evolution of radiologic facilities toward "shareable" high-quality display devices that allow more convenient and cost-effective access to medical images and related data in complex clinical environments, resulting in a paradigm shift in data navigation and accessibility [36].
For physicians, wireless connected hand-held computers are gaining popularity as point of care reference tools. The convergence of hand-held computers, the Internet, and wireless networks will enable these devices to assume more essential roles as mobile transmitters and receivers of digital medical Information. In addition to serving as portable medical reference sources, these devices can be Internet-enabled, allowing them to communicate over wireless wide and local area networks. With enhanced wireless connectivity, hand-held computers can be used at the point of patient care for charge capture, electronic prescribing, laboratory test ordering, laboratory result retrieval, web access, e-mail communication, and other clinical and administrative tasks. Physicians In virtually every medical specialty have begun using these devices in various ways [37]. Communication capable PDA has also made healthcare very versatile and mobile. Carrying hundreds of patient files in a suitcase makes medical street outreach to the homeless clumsy and difficult. Healthcare for the Homeless--Houston (HHH) began a case study under the assumption that tracking patient information with a personal digital assistant (PDA) would greatly simplify the process. Equipping clinicians with custom-designed software loaded onto Palm V Handheld Computers (palmOne, Inc, Milpitas, CA), Healthcare for the Homeless--Houston assessed how this type of technology augmented medical care during street outreach to the homeless in a major metropolitan area. Preliminary evidence suggests that personal digital assistants free clinicians to focus on building relationships instead of recreating documentation during patient encounters[38].
In this background, a lot of work is going on in researching to make PDA more efficient in meeting the ever increasing need of the medical professionals. All the existing and ongoing projects try to build a bridge between service providers (doctors, nurses, or paramedics) and some kind of external events (like a patient at home, emergency situations at some place, etc). In this way, technology is used to increase the interaction between patients and doctors, assisting service providers by giving them needed information. In our approach, we have tried to use pervasive computing technologies for situations that occur at he medical center. We have incorporated this technology using PDAs for information sharing in emergency decision making situations. This will also provide a means for patients to more fully participate with their physicians in managing their healthcare. This project will also provide a smooth pathway for better continuity of care for the patient, as well as a smarter doctor-doctor interaction. These benefits will, in turn, create a safer health care delivery system with reduced chances of medical error. A more efficient learning environment for the trainee physicians or medical students will be created. Our main focus areas are the sign out, endorsement, consultation or other patient related communications that go on constantly among the physicians and other healthcare professionals such as nurses, resident doctors working in-house. Our approach tries to adopt this promising technology in such a way that it maximizes the use of limited hospital resources, while at the same time creates a faster 21st century communication portal among the in-house physicians.
To provide support for our application, a middleware named MARKS (Middleware Adaptability for Resource Discovery, Knowledge Usability and Self-healing) [2, 20, and 22] has been developed. Along with several core services, it ensures the services of Knowledge Usability [19], SAFE-RD [21], Ubicomp Assistant Service [25], and GETS Self-healing [23]. From a user’s perspective, MARKS provides these services in a ubiquitous and transparent manner. Some preliminary work has been presented in [27]. In this paper, we have presented the details of our application along with extensive survey results.
Several scenarios are depicted in section 2 where our ‘Healthcare Aide’ provides the perfect solution. Section 3 describes several healthcare projects with related goals. Characteristics and challenges are discussed in Section 4, and functional requirements of ‘Healthcare Aide’ are reviewed in section 5. How ‘Healthcare Aide’ adheres to the required characteristics is presented in section 6. Graphical representations showing the placement of MARKS and ‘Healthcare Aide’ and some screen shots of the prototype have been added as supplements. Section 7 deals with how to use ‘Healthcare Aide’. The evaluation details have been portrayed in section 8, which is followed by conclusions and future directions in section 9.
2. Motivation
Scenario 1
Dr. Jones, a resident doctor in a hospital, has fourteen patients in his care and he needs to sign out detailed information about all of his patients to his on-call colleague Dr. Smith. Normally, Dr. Jones would have to use the telephone to give verbal sign-out instructions for Dr. Smith to write down. Or he would retype all the patient information from his hand-held device and somehow make it available to Dr. Smith electronically. Now with “Healthcare Aide”, Dr. Jones can simply and with little effort transmit his patients’ data from his handheld device to Dr. Smith who is working somewhere else in the medical center. While observing the patient, Dr. Jones took some notes and in the evening when he leaves, new doctors will take charge. Before signing off, Dr. Jones needs to inform the evening shift doctors of his findings. He makes his observations and comments about the patients available to the associated evening shift doctors instantly and effortlessly with the use of Healthcare Aide.
Scenario 2
Suppose a senior medical student was performing his duty in the Intensive Care Unit (ICU). Suddenly he noticed something unusual for a particular patient. The medical student was not familiar with the symptoms and was not sure about whom to consult or how to manage the situation. He broadcasted a message containing the symptoms so that all the available in-house residents and other senior medical students received his message. One of the doctors, Dr. Morrice, understood the situation and could respond on the fly via his PDA. The medical student had followed the recommended procedures. Within a couple of minutes Dr. Morrice reached the ICU and took charge. Within this small passage of time, medication was able to be quickly administered which may have saved the life of the patient.
Scenario 3
Ms. Becky has been admitted in the gynecology department of a medical center for some complex problems, the exact etiology of which is still unclear. She was under the care of Dr. Fin, who had prescribed medication. However, the patient wants to consult with other physicians about her condition. In situations such as this, rather than calling up various physicians from different sub-specialties in search of the right physician, a palm device can be used to broadcast patient information to the PDAs of all other physicians; this would save time and cause little inconvenience. Both Ms. Becky and Dr. Fin could get help in a timely manner.