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Design of Health Technologies
lecture 1
John Canny
8/29/05
Outline
Background on Health and Health Care
Goals of the course
Course format
Background
Current estimates of the cost of health care in the US put it
at 1.8 billion (about 4x the defense budget).
Health spending is about 15% of US GDP, much higher
than European countries or Canada.
Health costs in the US are accelerating again, after a
steady period in the 1990s.
The health care system is under stress – CHCF report.
Negative Effects of Cost Escalation.
What can technology do?
Acute care (i.e. hospital & outpatient treatment) is
dependent on technology more and more:
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New wonder drugs
New imaging techniques – MRI, sonar etc.
New diagnostic methods, DNA chips, biosensors
Minimally-invasive surgical methods
Radiation treatments
These approaches are very powerful, and very specialized.
We wont be covering them in this course (but see Ruzena
Bajcsy’s course from last Spring).
What can technology do? - EMR
But actually, medical “treatment” is only a part of the
health care challenge…
A surprising challenge is medical record-keeping. Caregivers today spend a significant fraction of their workday
documenting their work (Newhouse talk, forthcoming, and
note the “administration” category in the CHCF report).
Electronic Medical Records (EMR) promise to
streamline and improve care. It is near the top of every
HMO’s priorities, and most have an EMR strategy unfolding.
EMR challenges
EMR challenges many areas of IT:
Record security and privacy
POE transcription (Physician Order Entry)
Human-Machine interaction – efficiency, low error rate
Data mining – better care, better economics
Multimedia storage and retrieval
High availability and persistence
Interoperability
New technologies for EMR could enable much more
effective field studies of medical interventions (drugs as
well as lifestyle changes). See Newman presentation…
EMR challenges: Adoption
EMR faces major adoption challenges in the short term.
Many care-givers have developed their own record-keeping
practices, and are reluctant to adopt wholly new ones.
Nurses bear the brunt of record-keeping today, but often
have minimal say in the adoption of new systems.
Several early record-keeping systems failed because they
were built for idealized practices, not the actual
practices of working care-givers.
Health in the large
Almost all the health budget today is spent on acute care,
but most experts argue for a general approach to health.
This should include the home, facilities for palliative and
elder care, and other supports. The reasons are:
Lifestyle can dramatically influence health –
Obesity, Psychological health, Mobility
Health care costs increase sharply with age (4x >60)
The boomer generation is aging (2010-30 retirement)
Expected lifetime for a child born today is probably >
90 years
Diagnostic tools
Personal Health monitoring in the home:
Blood pressure, pulse, temperature, glucose…
Home diagnostic challenges
Clearly, these systems need to be reliable, accurate, and
secure (beware wireless links).
The inference done on this data needs to be robust as well,
minimizing false positives and negatives.
Many simple tests today (e.g. blood pressure) require nontrivial skill – the accuracy reports by customers are wildly
different – suggesting there is a big range in skill.
Usability of home medical tests is going to be a big issue
for the foreseeable future.
In-vivo diagnostics
Some types of monitoring, e.g. glucose monitoring for
diabetes, must be invasive.
But tiny implanted sensors are a new option.
E.g. the Grimes group at Penn State builds
magneto-elastic sensors that measure glucose
levels under the skin.
Other groups, e.g. Intel Seattle, are working on modified
RFID tags that produce a few bits of sensing (WISPs).
Diagnostic tools
Activity – accelerometers, pedometers, heart rate and GPS
e.g. Suunto’s T6, Footpod and X9i
Fitsense pacer and “bodylan”
Diet
A few university projects have looked at estimating caloric
input using sensed data:
Jen Mankoff at UCB: used PDAs to scan receipts
Kay Connelly at Indiana: used
product barcodes
The goal is to guide users
toward better dietary choices.
Telemedicine
Telemedicine is an attractive alternative to visits to the
hospital or doctor’s surgery.
Telemedicine typically involves teleconferencing in
conjunction with some remote diagnosis sensors.
It can also support continuous patient monitoring.
e.g. the Health Buddy:
Telemedicine – Health Buddy
http://www.healthhero.com/products_services/health_buddy_demo.html
Clinical Decision-Making
Medical diagnosis and treatment are decision problems with
incomplete information, and can be automated.
Probabilistic methods are well-established today. They
work well in constrained decision problems with few
variables – symptoms, patient demographics and health.
Decision-making is often case-based – a system’s decision
is supported by the retrieval of a set of relevant cases.
Clinical Decision-Making
But there is still a desire for “naturalistic” or human-like
decision-making. Machines have a difficult time narrowing
down an unconstrained decision-problem.
When the datasets are broad and sparse (like a doctor’s
clinical experience), automated inference stalls.
Alternatives include “situated cognition” or “activity based”
inference.
Health in the Developing World
Health measures – esp. infant mortality and life expectancy
– are often used as the measures of development.
Those countries which have made dramatic economic
progress in the last few decades (e.g. India and China),
have made similar strides in health.
Life Expectancy in India
Infant Mortality in India
Per 1000 live births
Economic Growth
China and India since 1980 have been among the fastestgrowing economies in the world.
China’s GDP growth, around 7% per year, is the highest in
the world.
India is not far behind with a 6% annual growth.
Health in the Developing World
The gains with economic development are not automatic
however. Both India and China built strong public health
systems.
They instituted vaccination programs, regional hospitals,
and high-yield agriculture (green revolution) to provide
adequate nutrition to everyone.
In the rush to economic liberalization, some of these gains
appear to be eroding.
Health in the Developing World
Poor health drains economic growth in many ways –
Absenteeism and low productivity at work
Costs of medicines and treatments
Excessive birth rates, infant and child mortality
Jeffrey Sachs (author of “The End of Poverty”) argues that
health problems have been the biggest obstacle to growth
in recent years in sub-saharan Africa.
Inadequate health creates a downward spiral back into
poverty
Health in the Developing World
Some health challenges in the developing world:
– Clean water/sanitation
– Inadequate nutrition
– Lack of access to doctors and medicines
– Respiratory illness
– Reproductive health
– Malaria
– AIDS
– Meningitis, Cholera, other epidemics
Health in the Developing World
Many of these challenges don’t require exotic solutions, but
might be improved by simple, locally-appropriate solutions.
e.g. Smoke monitoring (~ $2 sensors) + smoke hoods
(Kirk Smith)
Water
Satellite data in India is used to map likely targets for wells
with very high accuracy (from 30 to 90%).
Local sensing (via cell phones) might achieve a similar
result.
Some coordination of water use would be extremely
valuable, since there is often competition for available
wells.
Medication
Tracking medicines and dosages is a big challenge in many
developing countries.
The same techniques used in developed countries seem to
work (bar code scanners/terminals), but they need to be
very inexpensive.
Several programs have been
developer to support barcode
reading on cellphones:
Airclic, Motorola, SonyEricsson
Telemedicine
Telemedicine is seen as
an important part of the
health care puzzle in
almost all developing
countries.
The health center in
Amrita, Kerala, India
serves 34 local sites.
Uses satellite links…
diagnosis, telesurgery.
Outline
Background on Health and Health Care
Goals of the course
Course format
Course Goals
Familiarity with emerging health challenges
Select a topic for a course project
Build a team (2-3 people) for your project
Develop a prototype throughout the semester, using a
human-centered design process:
– Needs analysis, interviews, observation*
– Informal prototypes
– Design iteration
Human-Centered Design
Health care (and health maintenance) are complex social
practices. Technologies that are not adapted to those
practices are apt to fail.
In medical jargon, you
have to test health systems
“in vivo”, not just “in vitro”.
Prototype
Design
Iterative design keeps user
needs in the loop.
Evaluate
Participatory Design
Users of an IT system may be excellent designers:
Historically, doctors have been responsible for health
innovations of all kinds. They are excellent potential critics
and design partners.
Nurses are also health experts, and understand clinical
practice at all levels.
Participation helps technology adoption. When
stakeholders participate actively, there is a much better
chance their needs are addressed.
They also feel ownership of the innovation.
Participatory Design
In developing regions, contextual factors can be extremely
difficult to anticipate.
Participation by actual users can be very hard, but is
worth attempting.
Otherwise, local experts can represent users’ interests on
the design team. These are people with extensive field
experience with the target community.
Outline
Background on Health and Health Care
Goals of the course
Course format
Course Format
Guest Presentations – format will vary but normally a
presentation followed by Q&A. There will be a ready
assigned by the guest speaker. You should come prepared
with questions based on it.
Regular Classes
Each week there will be an assigned reading,
one student will give a presentation (1/2 hour),
short post-script by me,
then small group discussion,
and some questions to look for in the next lecture.
Course Format
Homework: For each class you should turn in a
summary (1/2 page or so) of the reading for that class.
Projects: Projects can be computer programs, electronic
or mechanical prototypes, studies or designs that address
a health challenge.
Project planning starts after the first section of the course
(weeks 1 to 3).
Questions for next time…
Normally, I would give you some questions to think about
as you read the next reading…
The next reading is “Medical Data: Their Acquisition,
Storage and Use”, which is chapter 2 from Medical
Informatics: Computer Applications in Health Care
and Biomedicine, by Shortliffe and Perreault, Springer,
2001
That reading comes with its own set of framing questions,
and some discussion questions at the end. These are all
you need..