Category Archives: Technology for the Visually Impaired

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.

The Six Million Dollar man 40 years on. Wearables, Smartphones, 3D printing. Cost to you <$100k!

As a teenager in the 1970s I loved Steve Austin, the astronaut who crashed and was rebuilt. Remember the tag line “Gentlemen, we can rebuild him. We have the technology, the capability to make the world’s first Bionic man”! It captured my imagination and has come to the front of my thinking now as I consider the possibilities of using technology to compensate for the different disabilities affecting people today. Perhaps we can’t replicate the eagle-eye zoom or the leopard-like speed of Lee Major’s character, but we can certainly bring functional replacement or complementary devices and applications to bring the astronaut-specific re-build of the 70s down to a very affordable level today.

The price of electronic components is continually falling, fueling the consumer electronics boom. Smartphones, and their associated explosion of applications, leverage the mobile network and the cloud computing phenomenon to deliver a wealth of apps both mainstream and specific to certain conditions, often free or at a minimal charge. On top of this comes the wearables revolution: watches, bracelets, eyeware, hearing devices, patches and exoskeleton limbs. 3D printing also means that the manufacturing of specialist devices is literally at the push of a button and can be taken to the most remote part of the world, delivering prosthetics to Africa at an affordable price point.

So how does the $6 million (not even allowing for inflation) look today? What gadgets, software and services could we pluck from consumer electronics retail outlets, apps stores and the medical community to build our modern-day bionic person?

  • Smartphone – $500
  • Exoskeleton bionic hand – $20,000
  • Exoskeleton legs with muscle stimulated control – $30,000
  • Sight (glasses) – $2,500
  • Hearing – $2,500
  • Bracelet with haptic feedback – $500
  • Smart watch – $500
  • Skin patches- $50

Total = <$100,000

There are, of course, some very expensive options such as retinal implants which still cost $100,000s plus complex surgery. However, most of the shopping list is literally off-the-shelf, or even off-the-printer.

The individual will need a subscription to a mobile provider, and probably also a link to their home WiFi, to enjoy the luxury of controlling the various household devices and services in the smarter-home environment; and, outside of the home, to link with the smart village, town and city services that can also complement the items in terms of navigation, linking into public services as well as the broader business community.

The e-health perspective also needs to be built into the thinking. Some of the devices will link into social and e-health services. Some of the information loops could potentially be to doctors and carers without the individual even needing to be involved. In effect, multiple information loops will feed off and to the individual, whilst improved monitoring and reduced cost of maintaining contact will help fund installations where required.

Steve Austin was funded by the US government in the TV show. In the case of a person being disabled through an accident, insurance would doubtless be involved, as would the medical authorities. Most of the items here are off-the-shelf and affordable for a vast swathe of society, not just limited to astronauts!

The world’s billion disabled people (source WHO) will have an increasing chance of joining in the digital revolution at home, at work and in society as a whole if we all help bring it to their attention. We also need to educate other relevant parties – family and friends, doctors and governments to name a few.

In the year that we all went Back to the Future, it just goes to show that time spent watching TV as a teenager wasn’t wasted. In Thunderbirds and Joe 90, Gerry Anderson predicted video mobile phones, Telepresence and brainwave transplants, and don’t forget the crew of the Starship Enterprise had mobile devices. If you want to predict the future, keep an eye on the TV!
six million dollar man

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What tech is out there for disabled people?

Recent interview with Telefonica about accessibility technology available today and in the future. I’m not the one in the bow tie….

Lewis Insight Interview with Telefonica

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You’re blind: How do you ‘read’, join in social media and find your way around, let alone run a business?

Picture the scene: a blind man walking down the street moving white stick to and fro. He is muttering to himself while clicking a small black thing in his left hand. What is he doing? Actually, he is running his business, doing email, messaging, reading documents, checking-in for his flight and working out the best route using bus and tube to get to the airport. The black device is a mini keyboard, controlling the iPhone in his pocket and it is talking to him via his in-ear Bluetooth device….

Having been registered blind for over 30 years, I am accustomed to the regular question about how the hell do you run a business? I thought it worth while to put this down in writing both as a record of how things stand in 2015, but also as evidence of how my world has changed since the days of cumbersome magnifiers, papers being sent off to be recorded, and very clunky interfaces with early PCs.

Equipment & technology

  1. iPhone 6. This is my main means of consuming content and keeping up to date using the built-in Voiceover feature, (not Siri) as a screen reader that describes to me what is on the screen. Add to this larger than necessary device (the screen size is irrelevant to me) is a small mini Bluetooth keyboard, the RiVo, which I use as a remote control to the iPhone (leaving the phone in my pocket or bag) and a Plantronics Bluetooth earpiece.
  2. Lenovo laptop with Windoweyes and Zoomtext: I still use a laptop for main content creation such as this blog. This is now simply on account of the fact that I like the feel of a full old-fashioned keyboard and a large screen magnified to make me feel I am still working properly! There are no specific built-in applications on the laptop beyond this add-on assistive technology. Updates to Windoweyes and Zoomtext can often cause problems because their interworking with either the hardware from Lenovo or the Windows operating system is a continuous struggle.
  3. Standard TV: On the main TV in the house I do insist on Audio Description being turned on so that I can better follow those tricky dialogue light films and programmes. The verbal description woven in between the actual dialogue often enhances the programme for all the family members – try it for yourself sometime!
  4. Victor Stream Reader from Humanware: This is the one specialist device I use. This no-screen device has very tactile buttons, long battery life and stores my talking books from Audible along with podcasts and access to live streamed radio and some Internet.

Apps

On the iPhone I have a mix of regular and specialist apps. The regular apps I use most often are:

  • BBC Sport:
  • BBC New: simple interface and straight forward despite the picture contents
  • Podcasts: annoying interface but great to have access to all that content: perhaps publish a list of my favourites at a later date
  • BBC Weather: simple and really useful when travelling around although not always accurate!
  • British Airways: for managing flights, getting mobile boarding cards – however, the latest version has lost some of its accessibility features and says ‘button’ an awful lot of the time!
  • Google maps: still struggling to get the most out of them but they are good
  • Virgin Media TV Anywhere to manage my set top box and record programmes
  • BBC iPlayer to give me access to my favourite radio  stations and podcasts
  • Twitter: pretty straight forward with Voiceover
  • Google docs to get access and manage my documents on my Google Drive: really useful when out and about
  • LinkedIN: somewhat easier to navigate than LinkedIn on the laptop/web but still clumsy
  • Hailo & Uber for taxis both work well once you have struggled through what needs to be input, when!

In terms of specialist apps, I mainly use:

  • Blind Square for finding restaurants, previewing menus and finding numbers to call for directions in case the map app fails
  • Be My Eyes: for identifying things via a video link to a volunteer when nobody sighted is around to help
  • Tap Tap See: ditto
  • RNIB Navigator: finding my way around and checking that cab drivers are not taking the micky
  • RNIB Overdrive: for access to the library of talking books and magazines!
  • Lire: not really a specialist app but it is a simple RSS app that scans the web for news feeds from your favourite sources.
  • Movie Reading: a beta version of an app that downloads audio description and synchronises with the cinema, TV programme or DVD
  • Camcard: a business card scanning app that uses the phone camera to scan and turn content into input for your contacts

Using the RiVo mini keypad does make navigating the iPhone a lot easier. It also makes typing easier. My preference is using it in the old T9 format, the one you would have used for text on your old Nokia phones. However, it does have a small QWERTY setting but I haven’t gone there.

Using the iPhone with keyboard and earpiece does mean that I can carry on doing email, listening to content, while walking along carrying my white stick. I suspect this is a little like people using their phones while driving but it does make my travel time walking, being driven, flown or sailed, a lot more productive and interesting.

As you may gather, I am close to dispensing with the services of a laptop if I can get a high quality full QWERTY keyboard that fits my aging fingers and suits my typing style! I would still plug it into a big screen in the office to give me the option of magnifying as and when necessary.

With most content now being available digitally and via the web or an app, I can consume and create content almost as readily as a sighted peer. Spreadsheets do pose a problem, as does Power Point. So, as with the apps world, I do draw on some human sighted assistance when this poses a problem.

The good news is that barriers are coming down, the more digital society gets, the more I should be able to join in on an equal footing.

I will keep you posted as things change.

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Accessibility At The Top Table At Mobile World Congress 2015

At Mobile World Congress in Barcelona last week accessibility took to one of the main stages. IBM, Microsoft, Google and the Mobile Manufacturers Forum (MMF) joined me to present perspectives on how accessibility is going mainstream.

I introduced the session with some of the key findings from the second Telefonica accessibility report “Digitising the Billion Disabled: Accessibility Gets Personal“. In summary, the billion disabled people represent a major spending group, combining earnings of some $2.3 Trillion and state support of $1.3 Trillion. Disabled people on average earn only 60% of their able-bodied peers and, of course, many disabled people don’t get the opportunity to work at all. 4% of children and 10% of the working population are disabled, but perhaps most striking, over three quarters of the elderly. Combine this dynamic with Douglas Adams theory of adopting technology getting harder as we get older and you can see the ticking time bomb of disability and age.

The good news is that the technology required to assist the Billion is getting more mainstream, affordable and accessible. Mobile sits at the centre of this change. As devices arrive with built-in accessibility, the emphasis shifts to the applications and web content being correctly labelled to trigger the necessary assistive input and output.

The flow of the session was as follows:

  • Frances W West, Chief Accessibility Officer at IBM told us how Big Blue has been dealing with accessibility for over a hundred years! She talked about ‘Millions of Markets of One’, a mobility accessibility app checker and a move to hyper personalisation in a broader context of smart cities. Accessibility is more than just accommodating disabled people; it is about inclusive innovation.
  • Rob Sinclair, Chief Accessibility Officer at Microsoft took us through the way in which they are “Rethinking Interaction and Design” educating their engineers around disability. The pentagrams he used to illustrate a reduction of peoples’ senses is a powerful method of raising awareness of a lack of vision, hearing, touch etc. Rob interacted with the audience to identify examples of temporary disability or situationally disability adding some more instances such as under water, gloved hands in the frozen North as well as the often cited driving example.
  • Eve Andersson, Manager Accessibility Engineering at Google introduced the accessibility features of Android including TalkBack, BrailleBack, magnification, switch access, captioning and Android Wear – an open platform for everyone to embrace.
  • Michael Milligan, Secretary General, Mobile Manufacturers Forum described the way in which the Global Accessibility Reporting Initiative (GARI) has compiled over eleven hundred mobile devices along with their accessibility features into a single database. Mobile operators can draw upon this database to highlight accessibility features to people when visiting their web sites or retail outlets anywhere in the world.
  • Henry Evans, Adaptive Technology pioneer then finished the session by presenting his view as a quadriplegic only having access through slight head and thumb movement to produce his presentation, demonstrating how he can use remote control robots to virtually visit museums around the world and fetch things from his fridge

I can honestly say that, being registered blind and interacting with Henry and his wife Jane via a letter board and the Beam robot on stage, was the strangest but most rewarding experience of over 25 years running industry conferences.

As well as getting accessibility on the main MWC agenda, it was also important to hear consistent messaging from the main vendors on stage. We all agreed that the worlds of accessibility and mainstream technology are converging. Most importantly however, we need education and training at every step of the value chain and channel to market. Disabled people themselves need to be better informed as to possibilities for complementing or replacing particular sensory experiences. And, the people training and educating the billion need better information and training. Like so many other eco systems, it is a matter of taking the holistic view and identifying individual actions that will help the overall flow. And, this is a matter for everyone to consider; it is about those who are disabled and those not yet disabled. The ticking time bomb of age, combined with the temporary disability during our daily lives, all means that this is becoming a more mainstream topic. Onwards and upwards everyone!

View the panel session here.

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Telefonica publishes Lewis Insight Report on Accessible Technology for Mobile World Congress

Digitising the Disabled Billion – Accessibility Gets Personal 2015 is released today to coincide with the start of Mobile World Congress 2015. #MWC15

This is the second in a series of white papers looking at disability and the role that accessible technology and services can play in bringing the ‘Billion’ into the digital world.

Chris Lewis will be presenting a summary of the findings at an Accessibility workshop on Wednesday 4th March at 2pm CET in the main conference area. Also presenting will be IBM, Microsoft, Google and the Mobile Manufacturers Forum, along with examples of accessibility in action. Follow it at #MCW15ACCS

You can also read my recent blog on this subject below.

IOT: the disability angle – from air conditioning to the self-drive car

Disability is most easily defined as ‘a limitation in a basic core activity of daily living’.

As an analyst, hearing so much about the Internet of Things (IOT) gets you thinking about how life will change. And as a registered blind person, it also makes me wonder what frustrations will be smoothed out by this pervasive technology.

Walking into my hotel room in China last week, I thought of some of the potential improvements that IOT might bring me when entering an unfamiliar environment:

  • I could control the air conditioning from my smart phone. I wouldn’t have to wonder which of the many buttons (assuming I can find the control) increase or decrease the temperature without the need to call the front desk to send someone to come and adjust the settings
  • I could switch the lights off without spending time feeling my way around electrical appliances and walls to find the oft hidden switches (and the often multiple types of switches on different devices)
  • I could set the temperature for my shower without deciphering how the different knobs affect the temperature and direction of the water
  • I could use my smartphone to turn the TV on, avoiding the labyrinth of menus on an unfamiliar remote control; play my music through their sound system and watch a film – yes, blind people do watch films – in English with audio description
  • I could actually set the safe without needing to share my passcode with a member of hotel staff
  • I could pull up the room service menu on my smart phone or laptop and see what they had rather than trying to understand the room service call operator as they attempt to read the menu to me
  • I could find the restaurant, the meeting room, and even break out of my hotel prison to visit the local shopping mall to find a present for my wife’s birthday
  • And how about actually finding my way to the gym without falling down several poorly marked steps (let alone almost tumbling into the outdoor pool!)?
  • Oh, and when I get into the gym, setting the tread mill or cross-trainer to the programme my trainer says I need to stick to in order to maintain the highly tuned body I have nurtured over the last 50 years

Being away from familiar surroundings just amplifies the need for a more helpful environment. At home, where things are more familiar, there is still a massive upside to remotely controllable central heating, lighting, washing machines, security, media and many more banal daily tasks that disabled people struggle with. And, don’t forget the imminent advent of an army of robots ready and willing to act as an interface to many of these devices as well as brewing the tea and fetching the biscuits.

When out and about, IOT enabled bus stops, buses, trains, shops, supermarkets, airports (literally everything), can feed information to allow people to better navigate, shop and interact with the environment let alone be a more engaged citizen on every level.

Never having been able to drive, my ultimate IOT goal is the self-drive car. The automotive industry has to make it so good that a blind person literally can ‘drive’ the car. Think about it!

There is no reason why the above, and many more issues, can’t be addressed by the IOT revolution. It requires some clear initial thinking around how applications are designed, how interfaces to smart devices are constructed. This will allow the billions, if not trillions, of devices and sensors to pool information and interact openly with my preferred smart device, peripherals and wearables.

Furthermore, it’s not just about empowering the individual in the home. Public services, including local authorities and, of course, healthcare organisation, can leverage the IOT to provide services into the home for the individual. Monitoring conditions, remote diagnostics, as well as a video-based consulting, could all improve service and reduce the cost of supporting someone.

So, this is a call to arms to all web & apps designers and to businesses thinking about embedding IOT and communications into their business processes: please design for all and allow the billion disabled people in the world – yes, 1 in 7 – to benefit from this radical adjustment to the way we run our daily lives.

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