Hospitals of the Future – Ubiquitous Computing
support for Medical Work in Hospitals
Jakob E. Bardram Centre for Pervasive Healthcare
Department of Computer Science, University of Aarhus Aabogade 34, 8200 ˚Arhus N, Denmark
Abstract. This paper describes the visions and on-going research within creat-ing ubiquitous computcreat-ing support for medical work in the hospitals of the future. Today, clinical computer systems seldom play any role in in the execution of clinical work as such. Electronic Patient Records (EPR) are more often located in offices at a hospital rather than at patients’ bedside, or in operating theaters. The are a number of challenges to the hardware and software design of contem-porary computer systems that make them unsuitable for clinical work. It is, for example, difficult to operate a keyboard and a mouse while operating a patient. Research within UbiComp provides a range of new conceptual and technologi-cal possibilities, which enable us to move clinitechnologi-cal computer support closer to the clinical work setting. An important branch of the research at the Danish Center for Pervasive Healthcare is to design and develop such new ubicomp computer technologies for clinical work.
1
Introduction
Studies of the usage of contemporary clinical computer systems in medical work in hospital have revealed that conventional computer technology designed for office use is inadequate for use in a hospital setting [3, 7, 4, 6]. There is a range of challenging properties of medical work, which makes it fundamentally different from typical office work: extreme mobility, ad hoc collaboration, interruptions, high degree of communi-cation, etc. – attributes that are in strong contrast to normal office work. In a hospital setting such a basic thing for desktop computers as a desk and a chair simply does not exist. Hence, there is a need for creating fundamental new concepts for creating computer systems in a hospital environment.
Based on observations like the ones presented above, we argue that researching the design and development of ubicomp technologies for use in hospital can be particular beneficial for the work of clinicians. In this paper we will present our research into the Hospital of the Future where clinical computer systems can become more tightly interconnected to the medical work of clinicians in hospitals.
2
Vision – The Hospital of the Future
The Hospital of the Future is a vision of a highly interactive hospital, where clinicians can access relevant medical information and can collaborate with colleagues and patient
independent of time, place, and whatever they are doing. Other researchers have used the term ’intelligent hospitals’ [11]. We prefer, however, the term ’interactive hospital’, because it in a better way covers the goals we are pursuing, and because we are not embedding any kind of artificial intelligence in the hospital. The vision of an interactive hospital can be divided into different research themes, of which we will consider some here. Examples from our vision videos can be seen in figure 1.
2.1 Infrastructure
We believe that in order to create a truly interactive hospital environment we need to devise a new kind of basic infrastructure upon which the clinical computer systems can be designed, developed, and deployed. As a part of its core execution environ-ment, this infrastructure must support the aspects of medical work already introduced above, and is to work as the computational spinal cord of a hospital. The infrastructure must support clinicians to move around freely inside (and outside) the hospital, while maintaining their computational environment intact. Clinicians should be able to move around while they initiate, pause, resume, and suspend their interaction with the clinical computer systems. The infrastructure should also ensure the proper inter-operability of the many different clinical systems in use at a hospital, providing basic mechanisms for developers of clinical systems to create highly integrated systems.
Important themes in such an infrastructure are:
– Collection of services – The infrastructure must support the work of clinicians and
try to encompass and adapt to the various services needed in a changing heteroge-neous environment. For example, a radiologist arriving at a conference room should be able to transfer his entire radiology conference from his PDA to a wall-sized dis-play.
– Secure – Such an infrastructure obviously needs to incorporate security for the
clinical applications running on top of it.
– Context Aware – We believe that creating context-aware clinical computer systems
is central to their adoption in clinical work. In a hectic working environment, where many tasks are carried out in parallel, where clinicians move from one setting to another, and where collaborative settings constantly emerge, it is important that clinical computer applications have a knowledge about the user’s working context and that they are able to adapt to this context. Support for context-awareness should be part of the basic infrastructure, rather than something each clinical application implements.
– Collaboration – We want to build mechanisms for collaboration into the very
ba-sic infrastructure of a hospital, because collaboration is so fundamental to clinical work. This can be used for setting up tele-medicine conferences between physi-cians and patients at home, but it should also support more ad hoc and situated kind of cooperation happening around public displays, like at the patient’s bed-side.
Fig. 1. Two frames from our vision video. The left-hand side showing the interactive bed and the right-hand side showing a remote radiology conference on a wall-sized interactive display.
2.2 Interactive Hospital Environments and Devices
Personal Computers are made for office work and are hence often difficult to deploy and use in a hospital, where there are no desks, chairs, or place for computer equip-ment. Therefore we envision that clinical computer applications are to be embedded in medical equipment and in the hospital as such. We are working on prototypes for creating interactive walls, ceilings, and floors, as well as embedding computers in hos-pital beds, pill containers, surgical tools, etc. We envision a hoshos-pital where clinicians can approach interactive surfaces anywhere and carry on their work. Some of these sur-faces are small and handheld like PDAs (but are not personal), others are large like the one used in a radiology conference room, where the whole wall is one big interactive surface.
An important part of this research is to develop and test new ways of modeling, rep-resenting, storing, manipulating, displaying, and using medical data or information. Medical records are to a large degree textual even when computerized. This is a very abstract way of representing medical knowlegde, which is tied to very physical aspects of human life. Simple things like using video in documenting orthopedic rehabilita-tion and in healing of wounds is desirable, but not easily integrated in exsisting EPR systems. Another important part of this research is to develop new ways of interact-ing with medical data and new kinds of ’interactive’ medical equipment. The keyboard and mouse are very hard to use at the bedside, for example. Hence we envision various kinds of multi-modal interaction needs to take place. For example, enabling the surgeon to access medical records and x-ray images using voice and gestures, while performing the operation.
3
Current Work
Our work so far has been concentrating on creating a basic infrastructure to be used in hospitals, and on creating some example of clinical applications running on top of this framework.
3.1 The ABC Framework
The ABC Framework is designed to be the computational infrastructure of the future hospital [9]. ABC is an acronym for Activity Based Computing, an architectural princi-ple also referred to as Task-Based Computing in the Aura project at Carnegie Mellon University [1, 12, 10]. In Activity Based Computing, the basic computational unit is no longer the file (e.g. a document) or the application (e.g. MS Word) but the work activ-ity of an user. Users can simply carry with them around the hospital the various work activities that they are engaged in and seamlessly transfer these from one computer to another. Actually, we no longer talk about ’computers’ anymore but about ’public displays’– even PDA are considered public, and not personal. These public displays are embedded in floors, walls, medicine cabinets, beds, etc. A prototype of a wall-sized public display is shown in figure 2.
The main goal of the ABC framework is to provide a programming platform for the development and deployment of computer applications that can be used in our activity-based computing concept. This is achieved by having on the one hand a runtime infras-tructure, which handles the computational complexities of managing distributed and collaborative activities by adapting to the available services or resources in a specific environment. And on the other hand by having a developer’s framework, which helps the programmer to create ABC-aware applications that can be deployed in the runtime infrastructure.
Fig. 2. The current implmentation of the vision shown in figure 1. Left-hand side: The interac-tive bed. Right-hand side: A prototype on a public wall-display. A nurse is having a real-time conference with a radiologist.
The ABC Framework embeds the following sub-components:
– A context-awareness sub-systems – A central part of the ABC infrastructure is a
context-awareness sub-system which continuously monitors the users’ context and gathers context information. This context-awareness sub-system can be accessed from clinical applications, or the it can be setup to notify applications when appro-priate. Our EPR application uses this sub-system to display EPR data for the nurse
in the medicine room based on information about the nurses current activity. This is for example monitored by looking at which patient’s pill container she is holding in her hand.
– An user authentication sub-system – Another sub-system help us accomplish what
we have termed ’proximity-based user authentication’ [5]. This enables user to be securely authenticated on a public computer just by approaching it.
– A collaboration sub-system – The framework embeds basic support for
collabora-tion [2]. All activities are in principles shared, which means that users participating in an activity can access it and collaborate ’in it’. For example, if a radiologist cre-ates a ’radiology conference activity for medical department B’, s/he can invite all relevant participants to the activity. This means that everybody can ’join’ this activ-ity and they are conducting a real-time conference using whatever computer they are logged in to. The session can be recorded for later playback by participants, who did not take part in the conference.
– A social awareness sub-system – Central to the collaboration support in the ABC
Framework is a system which helps clinicians to judge who and how to initiate a collaboration session. This system tries to provide clinicians with a peripheral, social awareness on what their colleagues are doing. This social awareness system uses information about the activity and context of users.
3.2 The Interactive Hospital Bed
As an example of an ABC application we created the ’Interactive Hospital Bed’ (see figure 2). The bed has an integrated computer and a touch sensitive display. Further-more, the bed is equipped with various sensors that can identify the patient lying in the bed, the clinician standing beside the bed, and various medical ’stuff’ embedding RFID tags. In this way the computer can adapt the computer screen to the users in its vicinity. For example, when the nurse arrives with the patient’s medicine, the bed is able to log in the nurse, check if the nurse is carrying the right medicine for the right patient, and it can display the relevant information on the screen, typically the medicine schema from the EPR system. Furthermore, various medical sensors measuring things like blood pressure, temperature, etc. can be attached to the bed and start using the on-board computer as a gateway to the basic infrastructure. Every bed is in itself a server containing various information about its patient and can be queried from e.g. an EPR.
4
Conclusions
In this short paper we have tried to outline our current research into creating new tech-nologies for the hospital. This research is tightly connected to the research field of UbiComp, as well as related research field like CSCW, HCI, and Software Architec-ture. The current status of our work is that it has been tested extensively in our labs, but has not been deployed in real hospitals. We hope to begin to incorporate some of the concepts and results from our research into the systems running in hospitals. To do this we currently engage in cooperative project with the EPR and healthcare industry in Denmark.
Short Biography for Jakob E. Bardram
Jakob Bardram’s main research areas are pervasive and ubiquitous computing, dis-tributed component-based system, computer supported cooperative work, human-computer interaction, and medical informatics. Currently, his main focus is ’Pervasive Healthcare’ and he is conducting research into technologies of future health – both at hospitals and in the patient’s home. Currently, he is managing a large project inves-tigating technologies for ”The Future Hospital”, which includes (among other things) embedding ’intelligence’ in everyday artifacts within a hospital, such as in the walls of the radiology conference room, in the patient’s bed, in the pill containers, and even into the pills. Additionally, he has done research into the design and development of computerized medical records, especially focusing on the support for mobile work and clinical cooperation.
Jakob E. Bardram received his Ph.D. in computer science in 1998 from the Univer-sity of Aarhus, Denmark. He currently directs the Centre for Pervasive Healthcare at Aarhus University [8].
References
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