Category Archives: Healthcare

Autonomous vehicles and their unexpected consequences: an accessibility Mexican stand-off

I recently joined an Institute of Engineering & Technology (IET) workshop looking into some of the unexpected consequences of autonomous vehicles. The IET will be producing a report shortly but I’m here to promote the accessibility design agenda.

The technical capabilities of the vehicle, the compute power on board for navigation, vehicle management and entertainment are mind-boggling. To be totally autonomous they need to be independent from any external inputs but they will also benefit from the explosion of external data sources. The impact on city planning, traffic, parking and overall public services will be life-changing for everyone.

Doubtless the vehicles themselves, becoming more sentient, will be very grateful for the increased levels of communications, new information sources and peer-to-peer information flowing between fellow road users as well as input from the streets and other city constituents. Making sure these information flows are bi-directional, linking the on-board vehicle systems to city information sources such as traffic and buildings information is also essential to bring the passengers to the right door for a wheelchair user, to have the robot or drone deliver the package or to find the right assistance for a vision-impaired person trying to find their way into the mall.

However, what really needs careful consideration is the user interface for these vehicles and their associated services. The most important issue is to get the wide variety of different users with different levels of IT skills and accessibility to initiate the autonomous vehicle and assisted travel through their preferred means. And, of course, if someone else orders or initiates the service, for the person to be communicated with in their preferred manner.

Designing the interface from scratch with inclusivity in mind will save the painful and often fated fall-back position of add-on development needed for different disabilities.

The good news is that the work being done around omni-channel customer experience with its multiple options for communicating with people and machines, addresses many of the issues. Add to this upfront design that embraces the accessibility features of smart phones, tablets, personal assistants and home automation systems and we have the beginnings of an inclusive design.

The justification for this is not necessarily just around including all disabled people in the digital economy. No, inclusive design actually makes it easy for everyone to use a service. Some people like talking to their app, some like interacting via a touch screen, some might even prefer the old QWERTY keyboard approach.

Artificial intelligence and machine learning will also contribute to the smooth incorporation of all users into the emerging scenarios. For example, once an individual with particular needs is identified as having ordered an autonomous vehicle service, the system can route a specific vehicle, possibly specially adapted, to the desired location.

Autonomous vehicles can then contribute further in terms of local authorities streamlining their service to people requiring home visits, social care and, of course, linking them into the healthcare systems. Ambulances will be redefined with autonomous driving and the paramedics able to concentrate on looking after the patient.

So, we should also be excited about the impact of autonomous cars on groups previously precluded from driving. New ways of spending time while transferring from one place to another, entertainment, work, rest, will appeal to all customers but we must allow for the human machine interface and offer that interface in a variety of ways that suit all users under all circumstances.

One final thought: what happens when the autonomous vehicle senses a person with a guide dog and the guide dog senses an approaching vehicle? A Mexican stand-off – go find the algorithm for that one!

Keep an eye out for the full IET report coming soon.

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The Hyper-connected individual meets the Healthcare system

At the Great Telco Debate last year, one of the biggest laughs was when my co-host Graham Wilde was attacked for buying his wife a FitBit, implying she needed to lose weight! The success of these so-called health tracking devices, and their associated apps, is an indication of how wearables, combined with smart phones and tablets, are beginning to change our behaviour and our lives.

Outside the healthcare industry, these devices with their life-changing outputs are seen as wondrous. However, inside the healthcare sector, they are often dismissed as being toys providing inaccurate and misleading information.

The consumer electronics industry, with its dynamic gadget crazy geeks, coming up against the established healthcare profession, with its hospitals and insurance organisations, represents a key battleground for us all. Regulation in the medical area is rife, and so it should be. Consumer electronics is a considerably more liberal environment. So we have the challenge of making money and identifying new markets on the one hand, whilst accurately treating people with illness and disabilities on the other.

In previous articles I have considered the world’s billion disabled and opportunities for assistive technology in the form of regular smart phones, wearables, apps and the Internet of Things (IoT). I now think it is worth expanding the discussion to include the broader healthcare industry. The simple reason is that if we get it right for the healthcare sector as a whole, the solutions will include everybody, whether suffering from a short-term illness or long term disability.

We all have experiences which involve the healthcare system at some point in our lives. As with many industries, the Internet and availability of smart devices of all types gives us an insight into a world that was previously shrouded in mystique.

From home: remote diagnosis

Before we even enter into a doctor’s surgery or hospital, we are armed with information from our web searches and data from our mobile health lifestyle apps. Exercise, diet, alongside our essential measurements are tracked to give us an indication as to how we are doing. A blip in how we feel, or in the data, might trigger an Internet search – often leading to inaccurate self-diagnosis and unnecessary alarm.

Today we are seeing the beginnings of new fee based services where medical professionals provide consultation via online chat or even video . In many circumstances, such interaction will be sufficient to satisfy the ‘customer’ that everything is fine; or can generate sufficient advice, or even a prescription, to address the issue. If not, escalation to a more formal, traditional consultation will be necessary. This potential virtual triage could be useful for the industry in reducing the number of people unnecessarily entering the ‘real-world’ healthcare system.

The traditional medical system

In surgeries and hospitals, medical professionals can benefit from costly devices and services necessary to diagnose and treat the individual. These devices are increasingly connected through multiple channels allowing even remote specialists to access the patient records and produce a diagnosis. Furthermore, scans which were previously too big to circulate, are now fizzed across the network infrastructure for everyone to share on their multiple self-provided or hospital-provided devices.

Furthermore, we shouldn’t lose sight of the fact that a specialist surgeon could perform an operation via a robot, and indeed with a virtual scalpel, given the right connectivity, video and local support.

And, of course should the condition be acute, an ambulance also completely connected to the medical facilities can be dispatched with diagnostics and treatment carried out by the paramedics. Perhaps we could think of this as mobile triage!

Following medical intervention, physicians and nursing staff are increasingly armed with sophisticated bed-side monitoring equipment, once again feeding into central patient records. However, this is increasingly being complemented with more smart phone based offerings. That’s not to say the clipboard on the bottom of the bed will disappear, but that this ‘analogue service’ will be complemented by electronic versions with analysis and alarms to notify staff.

Developments in devices, sensors, applications and medical add-ons are all helping to change the dynamic of treating conditions:

  • Self-administered blood monitoring is radically changing the treatment of diabetes and dramatically lowering the levels of insulin required
  • Pseudo off-the-shelf 3D-printed artificial limbs are accelerating limb replacements
  • Sensors, cameras and microphones are allowing sensory enhancement or indeed replacement.

Smart phones are the unifying element but this doesn’t have to be the case. We will doubtless end up with many separate connections and data flows from our bodies to our carers, physicians or indeed to our own smart devices.

Aftercare

On leaving the formal hospital environment, there are now many new opportunities to reduce the frequency of return visits and reduce the cost of supporting the patient. The aftercare hitherto confined to follow up consultations at the hospitals can increasingly be delivered via video-based services and ideally some more dispersed facilities in the local community. After all, consultation on how well a hip replacement or skin condition has improved can just as easily be done over a Skype link. As with many industry transformations, this requires an organisational, process, financial and cultural shift. If the follow-up consultation is carried out perfectly well by video link, why should it only command a fraction of the fee usually assigned to an in-person or  in-hospital consultation?

Social care

Follow up social care, whether in the person’s home or in a social care unit, can also benefit from this ultra-connected world. The vastly expensive scanners obviously cannot be dispersed out into the community, but care staff and patient associations can use much simpler, slimmed down technology as well as some of the more consumer-electronics like devices and the myriad of apps to give both the patient and the carer a better-informed understanding of activities. Scheduling appointments is an obvious first step to make better use of care staff. But simple data gathering from questioning the patient, or using medical devices operated by the carer, will certainly be of incremental value to any consumer-like devices in the form of blood pressure or heart-rate monitors and motion detectors.

And, if a doctor is required to visit the patient, then mobile devices such as ECG machines can feed data back into the patients’ records over cellular or WiFi networks.

Long term care is a major focus for the industry today. With an increase in chronic conditions and subsequent drain on resources, anything which can reduce the total cost of this service, whilst improving the quality of care given to individuals is a ‘no brainer’.

The journey

So, the entire journey from initial Internet search, through formal medical intervention, to aftercare can benefit from the better connected environment. There is, of course, the issue of who pays – public or private. This depends to a large extent on individual countries. No doubt, the best use of fixed broadband/mobile technology, smart phones/tablets, wearables/IoT, consumer/industry-approved apps and a willingness for all parties to adapt to the new environment will pay massive dividends.

Who can argue that the future daily routine of a nurse or doctor will consist of a couple of hours on face-to-face duty, followed by a couple of hours online?

It is vital when designing devices and apps in this area that simplicity and accessibility for all levels of technical ability are built in from scratch. In many countries for the foreseeable future we have an ageing population that is not smartphone literate. This could be one way of bringing many into the touch screen world as long as we don’t confuse the issue with overly complex solutions. Technology exists to hide the complexity behind a simple interface or different accessible features depending if a person has limited vision, dexterity or mobility. After all, if we can build a button to simplify the ordering of a pizza, we can build an app button to address the key requirement for a particular patient and their needs.

What is clear, is that the lines of demarcation between home, formal medical facilities and after care are blurring. Volumes of data and information flows between all participants are increasing with personal and medical devices. Centralised patient records fed from all points are vital. Technology has to be embedded into simpler processes in order to underpin the new healthcare regimes.

We are all part of this particular journey. Let’s encourage all parties, patients, medical staff, administration and perhaps most importantly, politicians, that this is one way that technology can literally help us all to a better life. Many industries have been disrupted dramatically through devices, apps and connectivity. We could see a restructuring of the healthcare sector. Who knows, it might lead to more local services and a move away from the previous trend to bigger and bigger hospitals.

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