Context awareness in health care: a review

Coping with the unforeseen in surgical work

OBJECTIVE

The purpose of this study was to investigate how staff working in the perioperative domain copes with unforeseen events and in what way, if at all; they are supported in this by formal systems such as information systems.

DESIGN

Case study. We conducted our study in the Department of Surgery in a large academic hospital in Norway. The department consists of eight operating rooms for planned surgery. The study included observations and interviews, in addition to one design workshop with health personnel. We focused on planned surgery.

RESULTS

Our observations showed that unforeseen events that cause deviations from plans are characteristic and that staff apply different coping strategies to make the plan work regardless. Support of these coping strategies by formal systems is poor.

DISCUSSION

We used the concept of high-reliability organisations as proposed by Weick and Sutcliffe, 2007, to analyse the observed coping strategies. The coping strategies can be seen as examples of the principles for managing the unexpected that Weick and Sutcliffe propose. IT support for this must include both awareness-creating systems and systems that enable workers to control the effects of unforeseen events once they have occurred.

An ontology-based system for context-aware and configurable services to support home-based continuous care

Continuous care models for chronic diseases pose several technology-oriented challenges for home-based care, where assistance services rely on a close collaboration among different stakeholders, such as health operators, patient relatives, and social community members. This paper describes an ontology-based context model and a related context management system providing a configurable and extensible service-oriented framework to ease the development of applications for monitoring and handling patient chronic conditions. The system has been developed in a prototypal version, and integrated with a service platform for supporting operators of home-based care networks in cooperating and sharing patient-related information and coordinating mutual interventions for handling critical and alarm situations. Finally, we discuss experimentation results and possible further research directions.

Developing Smart Emergency Applications with Multi-Agent Systems

Multi-agent systems have been importantly contributing to the development of the theory and the practice of complex distributed systems and, in particular, they have shown their potential to meet critical needs in high-speed, mission-critical, content-rich, distributed information applications where mutual interdependencies, dynamic environments, uncertainty, and sophisticated control play a remarkable role. Therefore, multi-agent systems are considered a suitable technology for the realization of e-health applications where the use of loosely coupled and heterogeneous components, the dynamic and distributed management of data, and the remote collaboration among users are often the most relevant requirements. This paper describes some of the main reasons why multi-agent systems are today considered one of the best technologies for the realization and deployment of advances for e-health applications and, in particular, of smart emergency applications. After an introduction on the inherent characteristics of the use of multi-agent systems for e-health, the paper presents the results of EU-scale project CASCOM: a real multi-agent system for the execution of smart emergency tasks.

Guest editorial. Special section on personal health systems

This special section on personal health systems (PHSs) features 13 papers in three main areas: new-micro-nano instrumentation, sensors, and sensor-based systems; new information processing technology via embedding intelligence in PHS; and PHS platforms to address specific clinical applications.

Smart homes - current features and future perspectives

In an ageing world, maintaining good health and independence for as long as possible is essential. Instead of hospitalization or institutionalization, the elderly and disabled can be assisted in their own environment 24h a day with numerous 'smart' devices. The concept of the smart home is a promising and cost-effective way of improving home care for the elderly and the disabled in a non-obtrusive way, allowing greater independence, maintaining good health and preventing social isolation. Smart homes are equipped with sensors, actuators, and/or biomedical monitors. The devices operate in a network connected to a remote centre for data collection and processing. The remote centre diagnoses the ongoing situation and initiates assistance procedures as required. The technology can be extended to wearable and in vivo implantable devices to monitor people 24h a day both inside and outside the house. This review describes a selection of projects in developed countries on smart homes examining the various technologies available. Advantages and disadvantages, as well as the impact on modern society, are discussed. Finally, future perspectives on smart homes as part of a home-based health care network are presented.

Usability testing of mobile ICT for clinical settings: methodological and practical challenges

BACKGROUND

While much is known about how to do usability testing of stationary Electronic Patient Record (EPR) systems, less is known about how to do usability testing of mobile ICT systems intended for use in clinical settings.

AIM

Our aim is to provide a set of empirically based recommendations for usability testing of mobile ICT for clinical work.

METHOD

We have conducted usability tests of two mobile EPR systems. Both tests have been done in full-scale models of hospital settings, and with multiple users simultaneously. We report here on the methodological aspects of these tests.

RESULTS

We found that the usability of the mobile EPR systems to a large extent were determined by factors that went beyond that of the graphical user interface. These factors include ergonomic aspects such as the ability to have both hands free, and social aspects such as to what extent the systems disturbs the face-to-face interaction between the health worker and the patient.

CONCLUSIONS

To be able to measure usability issues that go beyond what can be found by a traditional stationary user interface evaluation, it is necessary to conduct usability tests of mobile EPR systems in physical environments that simulate the conditions of the work situation at a high level of realism. It is further in most cases necessary to test with a number of test subjects simultaneously.

Towards pervasive computing in health care - a literature review

BACKGROUND

The evolving concepts of pervasive computing, ubiquitous computing and ambient intelligence are increasingly influencing health care and medicine. Summarizing published research, this literature review provides an overview of recent developments and implementations of pervasive computing systems in health care. It also highlights some of the experiences reported in deployment processes.

METHODS

There is no clear definition of pervasive computing in the current literature. Thus specific inclusion criteria for selecting articles about relevant systems were developed. Searches were conducted in four scientific databases alongside manual journal searches for the period of 2002 to 2006. Articles included present prototypes, case studies and pilot studies, clinical trials and systems that are already in routine use.

RESULTS

The searches identified 69 articles describing 67 different systems. In a quantitative analysis, these systems were categorized into project status, health care settings, user groups, improvement aims, and systems features (i.e., component types, data gathering, data transmission, systems functions). The focus is on the types of systems implemented, their frequency of occurrence and their characteristics. Qualitative analyses were performed of deployment issues, such as organizational and personnel issues, privacy and security issues, and financial issues. This paper provides a comprehensive access to the literature of the emerging field by addressing specific topics of application settings, systems features, and deployment experiences.

CONCLUSION

Both an overview and an analysis of the literature on a broad and heterogeneous range of systems are provided. Most systems are described in their prototype stages. Deployment issues, such as implications on organization or personnel, privacy concerns, or financial issues are mentioned rarely, though their solution is regarded as decisive in transferring promising systems to a stage of regular operation. There is a need for further research on the deployment of pervasive computing systems, including clinical studies, economic and social analyses, user studies, etc.