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Towards a location based or context aware system in a hospital setting?

- technical issues- issues relating to use in the organization

Lill Kristiansen, Prof. Dr. Scient

Inst. for Telematikk, NTNUlillk@item.ntnu.no

www.item.ntnu.no/~lillk

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Content

Background / some of my previous work IP-telephony, calendar/location integration with

telephony,..(1999-2006) H.323. annex K, (later similar functionality in SIP/extensions) OSA/Parlay for call control in particular

The group-communication system implemented in pats (H2003) intended for nurses’ communication

A qualitative study of nurses’ attitude toward location tracking in a hospital

Studies of location, presence etc. in health care organizations by my students

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From tech. to tech. in use

I come from the technology side Building new technology and evaluationg the systems

from a technology perspective

Now interested in the whole issue of user, organization and technology supervising master student in systems engineering as well as master students specialicing in TOS ’Telecom.

Organization and Technology’

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Some previous tech. work of mine / my students

IP-telephony at Ericsson AS, Norway

Including integration of IP-tel. and url’s as described in H.323, ver. 4 annex K A generic mechanism for sending a url during call setup

phase, typically back to A during alerting (pre-connect) ’opening up’ the telephony network for presence and more

Also involved in architecture and standardization for mobility, OSA Open Service access for Ericsson

Later SIP, SIP-Jain, SIP session mobility based on location/context (with P-O Osland Telenor)

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Without opening up the telephony network ComPage (Teepo, UiO, 1999)

2) Click-to-call

Web-browser

3)

Callsetup H.323

1)

E.g.Net-

meeting

-

IP-based tel. netw.

Web-server withe.g. preferences / presence

PSTN-GW

webIP-netw

PSTN netw.

Call layer(Telcoproperties)

Service layerweb-based

Advantage: Simple

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Opening up the telco network with OSA

P-SCSFP-SCSF Visited B

S-CSCFS-CSCF

Home A

1

2

7

1517

P-CSCFP-CSCFVisited A

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AB

GGSNGGSNSGSNSGSN

Radio Access NetworkRadio Access Network

GGSNGGSNSGSNSGSN

Radio Access NetworkRadio Access Network

S-CSCFS-CSCF

Home B

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I-CSCFI-CSCF

HSSHSS

9

14

6

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I-CSCFI-CSCF

HSSHSS

5

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9B)

B’s presence service /screening rules (GUI via e.g. Outlook or MSN..)

OSA/ Parlay call control

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’Interactive screening’ using SIP (2005)

From Østhus and Kristiansen (2005) (WS instead of OSA was used)

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pats lab

I assume you have a basic knowlegde of the lab

I will briefly present the overall picture and ServiceFrame

Then a more detailed presentation of ” Group communication for healthcare workers designed in ServiceFrame” carried out by stud. Marte Forthun, fall 2003

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PATS lab: Available resources (2006)

Service engineering

Service deployment and

execution

Service Platforms/interfaces

Telenor Mobil WAP pushGSM loc SMS MMS

Bravida

Map

Incomit parlay GW

Ericsson Parlay GW

Incomit iSea ServiceFrame

Ericsson MMStreamingserver

Rational Rose

IBM Websphere

Telelogic(UML 2.0)

Mobilus

Radio-nor

WLAN pos

Red-MBluetooth

CPA

POI

Route

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PLMN(GSM/UMTS CS)

PSTN/ISDN (CS) IP Multi-Media (PS)

Capability Server(s)(including interface classes)

Application

Application Server

Application

Application Server

Application

Application Server

OSA Interface providing open API’s to Applications

Capability Server(s)(including interface classes)

Capability Server(s)(including interface classes)

Parlay and UMTS Open Service Access;

Migration and Convergence

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From methods and tools to running code

Access and transport network

Service Enablers

Tools Service Creation Environments

Methods

Terminals

Application Servers (Service Execution Environments)

Services

Access and transport network

Service Enablers

Tools Service Creation Environments

Methods

Terminal

soap

http

RMI, ...

Application Servers (Service Execution Environments)

Services

Services

Service engineering

Service

deployment and

execution

Service platforms

Parlay, OSA, JAIN, ...

APIs

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Application server: Service architecture

SCS

UserAgent

UserTerminal

ServiceFrame

TerminalAgent

AppliancesServiceEnabler

AgentASUSAppliance

Agent

ApplicationActor

CommunityAgent

Service Frame concepts

Edge towards the SCS Service capability Server(to OSA)

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Application Server: platform portability

Mod

elin

g

Platform SpecificModeling

Impl

emen

tatio

n

Platform lndependentModeling

.NET

.NET ActorFrame

Implementation using Actor classes

EJB

EJB ActorFrame

Implementation using Actor classes

Functionality using Actor model

JVM

JavaFrame

Implementation using Actor classes

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Medical Department

Stroke Unit

G1 G2 G3 G4 G1 G2 G3 G4 G1 G2 G3 G4

Heart Unit Kidney Unit

The following slides are from student Marte Forthun’s presentation (slightly modified)

Forthuns work was mainly technical. Example of a kind of ‘service composition’, introducing a new concept such as ’group’ into ServiceFrame

FICTITIOUS DEPARTMENT

Group communication for healthcare workers designed in ServiceFrame

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CONTEXT-AWARE INFORMATION

”Context is any information that can be used to characterize the situation of an entity. An enitiy is a person, place or object that is considered relevant to the interaction between the user and an application, including the user and applications themselves”

(Dey, June 1999)

USE OF CONTEXT-AWARE INFORMATION IN THE HOSPITAL

•Location: Indoor positioning – sensors

•Calendar: User’s calendar, group calendar etc.

•Sessions: Call sessions, instant message session, real-time sessions,..

•Role: Trained nurse, doctor,...

•Presence Types: ”Free”, ”Busy with patient”, ”Meeting”, ”Lunch”, ”Emergency”, ”Offline”

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SCENARIO 1 FROM TRONDHEIM UNIVERSITY HOSPITAL– HELP WITH PATIENT

Interface on handheld terminal or on PDA in pocket

Lise

Primary group - G1

Help Patient

Stroke Unit

Location: Room 333Presence: Busy with patientGroupSession: 1

17 Interface on handheld terminals

Location: Room 337Presence: FreeGroupSession: 1

Kari

Help Patient

Stroke Unit

Primary group - G1

Yes

Stroke Unit

Primary group - G1

No

Able to help in room 333?

Location: Room 333Presence: Busy with patientGroupSession: 1

Lise(Service) Network knows the presence information of all in group and routes the message

(Service) Network knows the presence information of all in group and routes the message

1

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4

OlaPer

Anna

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SCENARIO 2 FROM TRONDHEIM UNIVERSITY HOSPITAL– EMERGENCY

Emergency team

The patient’s doctorInterface on the terminals

Primary group - G1

Emergency

Stroke Unit

Primary group - G1

Stroke Unit

EMERGENCY IN ROOM 333

Location: Room 333Presence: EmergencyGroupSession: 1

Per

(Service) Network knows the presence information of all in group

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GROUP AGENT SYSTEM

GroupManager: Groupname, address, user’s group

GroupAgent: Groupname, users, access to update

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GROUP AGENT

UserSession: Real-time messaging, context-information

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Forthuns work

Her work was not tested on users because of several factors:

1. Pats did not support J2ME in 2003, i.e. user interface was not on handheld (but faked on a PC)1. hard to simulate a real scenario in this case

2. Pats did not support accurate indoor location at that time We had Radionor Cordis radio eye, but that is mostly suited for

places like Nidarosdomen (high ceilings) location from several sources was prepared for though

3. Today we have Radionor office indoor location integrated in pats i.e. in items corridor and Svanæs has Radionor1. Svanæs’ usability lab is not linked to pats though...

Also Forthuns work focus on session establishment, adding location info, ’group hunt’ etc She assumes ServiceFrame everywhere, no use of standards

such as e.g. SIP/GSM/3G or SIMPLE or MSN ‘standard’ That can be added of course

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Knappen ’The button’ study (2004)

Left: button for the nurse (on door frame in the room)

3 levels: ’help’, ’nurse need help, ’hearth arrest’

Middle: No nurse id , just indicating ’presence’

Right: Signalling a patient calling for help (ringeknapp) with room idOR signalling that a nurse is called (kalt opp)OR several numbers in round robin fashion

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Location based system in a hospital setting; an exploratory study

A qualitative study fall 06 Lill and two PhD studens (ifi, UiO)

RQ1 Automatic vs. manual sharing of information: Does it matter to the nurses if the location and status is shared

automatically or manually? For instance, are they more comfortable pushing a button when they enter a room to signal their presence, or is it OK for them to be tracked continuously as they move around? Are there places or situations where these issues are looked upon differently?

RQ2 Awareness of potential use and misuse of information: To what degree do the nurses realize the potential for use of

information when they are sharing location and status with others? Do they think differently about this depending on who they are sharing with? Does it matter if they share with fellow nurses, doctors, or management?

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Findings (1/3)

All our findings must be understood in the context of a ’nurse identity’ (Palen and Dourish (2003) ’ Identity boundary ‘) E.g. nurses concern with patients is a part of their professional self-image

Our three health experts had opposite views on ‘surveillance’ issues The 2 friends of same age showed opposite attitudes

Nurses are positive to showing location data to management in order to show how much they actually wallk/run

The health experts (nurses) were talking about manual work such as refilling of clean sheets and linen and food serving, and this led us to the concept invisible work Star and Strauss reports an attempt by a group of nurses at the University

of Iowa to categorize and make visible all the work that nurses do.

A location system may visualize (parts of) invisible work without ‘understanding’ the work (i.e. without a need to have a category for the work) (see e.g. Forthuns 6 defined presence categories) A human user can then ‘understand’/interpret the location and other

context info (without a need to have a category for the work)

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Findings (2/3)

A manual procedure for registering location our idea: to give them ‘more control’ and to introduce a system

close to the existing system maybe they are more interested in what the location info is used for

than to avoid registration as such

error prone (forget to register in hectic work) but with an ICT system a re-registration may cancel the forgotten

deregistration (unlike today’s manual system without id) ICT offers new possibilities, but hard for the nurses to imagine all our

thoughts

In most cases they wanted to see identity (role was not enough) todays system show no identity based on user id and location they felt they would be able to

guess on the activity /’get a sense of what is going on’

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Findings (3/3)

Nurses are quite aware of how such a system may be fooled and show wrong (mediation of reality) “You may have someone wear the badge for you” “You may have helped in at a hearth arrest on your way back from lunch”

(not having had a long lunch break) “A location system may register that ‘someone was there’, but it tells

nothing about the quality of the care”

The latter comment is important: Such a system may result in behavior adapted towards what is measured

(location) and may result in ‘fake care’ (presence, not care)

Nurses are positive to use such a system as partial evidence in case of a lawsuit after a death incident This requires a persistent system though Other use of the system may need only ephemeral data (no storage)

Will a location/presence system help or destroy enforcing / visualizing existing ‘rhythms’ or destroy all rhythms via ‘always accessible everywhere on every device’

and causing more interrupts?

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Further work

Mutual learning (Kyng, 1995) Did the health domain esperts understand our ideas as

presented orally? New possibilities not present in today’s wellknown system

was intended in our new system

How to involve health domain experts in the design? Presenting UML diagrams to health care domain experts??

Building prototypes e.g. via pats lab

User testing using pats infrastructure and live network and maybe

Trådløse Trondheim? In ’real life’ (maybe for home care? at hospital???) In ’big lab’ (empty place at St.Olavs in a new building?)

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Other health related work

Students in TOS Telecom. Organization and Society

Studies of technologies for home care workers Fall 2004-spring 2005

interrupts caused by calls Use of collegues and EPR /Gerica for info about patients

Spring 2007 Design methods for participatory design

testing out two different methods of running work shops Use of location, maps and cameras in home care

Studies in hospital use of location and e-tagging of medicine study of communication and coordination (quite close to Scholl

et al)

Studies of introduction of ICT based tool Sampro for ’Individuell plan’

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References

Scholl, J., Hasvold, P., Henriksen,E. and Ellingsen, G.,"Managing communication availability and interruptions: A Study of Mobile Communication in an Oncology Department" Accepted at pervasive07

Ellingsen, G. and Monteiro, E., A patchwork planet. Integration and cooperation in hospitals, CSCW the journal, 12(1): 71 – 95, 2003.

http://www.idi.ntnu.no/~ericm/patchwork.pdf Focus on ‘IT’-systems, such as X-ray, EPR. Less focus on ‘person-to.person-

communication’ My student Alex is working on this

Bydgås, S et al. MOSSA Telenor report ihospital.dk (head was Bardram, head is now Kyng, Bardram is with ITU now)

many publications but they are not looking into details of telephony session establishment, here item/pats

can contribute

Massimi, M., Ganoe, C., Carroll, J.M. 2007  Scavenger Hunt: An Empirical Method for Mobile Collaborative Problem-Solving, Pervasive Computing, Vol. 6(1), pp 81-87

http://ieeexplore.ieee.org/xpls/abs_all.jsp?isnumber=4101128&arnumber=4101146&count=17&index=13 About usability (HCI) testing ‘in lab’ and ‘in real’ Not about general use of system in an organizational setting

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References

Woodruff, A. and Aoki, P. M. 2004. Push-to-Talk Social Talk. CSCW the journal 13, 5-6 (Dec. 2004), 409-441.

http://dx.doi.org/10.1007/s10606-004-5060-x Interesting effects of ’instant listen’ with ’delayed answers’ Interesting comments on the ’limitations’ with semi duplex, turned out to be a nice to

have feature Teenage users in private setting Interesting to test on field workers such as trygghetspatruljen

Jones, Q., Grandhi S.A. Terveen L and Whittaker, S.2004, ,People-to-People-to-Geographical-Places: The P3 Framework for Location-Based Community Systems, Computer Supported Cooperative Work (CSCW), Volume 13, Numbers 3-4 pp249-282

http://www.springerlink.com/content/q465ph125r5681r5/ A conceptual framework, mainly focus on social tasks, dating/lunching etc

Wiberg, M. and Whittaker, S. 2005. Managing availability: Supporting lightweight negotiations to handle interruptions. ACM Trans. Comput.-Hum. Interact. 12, 4 (Dec. 2005), 356-387. http://doi.acm.org/10.1145/1121112.1121114

A study of how ‘talking sessions’ are established in offices today A propotype of ‘Negotiator’ for negotiating to call or be called up after x min. or

deferring the call for x minutes (running on PC and PDA) User evaluation of Negotiator in a lab setting using desks and not allowing any calls to

take precedence over the current desk activity, Interesting study, but some assumptions are not relevant for health care where some

calls will have higher precedence than current task

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References

PUSH-2-TALK IN VOIP DECENTRALIZED by Florian Maurer, presented at BB4All, IST project, supervised by KTH (using SIP/minisip) http://www.bb2all.org/papers/Maurer%20Push-2-Talk.pdf

Østhus, E.C., Osland, P-O, Kristiansen, L. (2005), ENME: An ENriched MEdia application utilizing context for session mobility; technical and human issues. Proc. UISW (workshop of EUC2005), LNCSE series 2005;Vol. 3823 pp.316-326 http://www.springerlink.com/openurl.asp?genre=article&issn=030

2-9743&volume=3823&spage=316 Using SIP extensions and web services (not using OSA) Demo build using model railroad and RFID

Østhus, E.C., Kristiansen, L.,(2005) A presence based multimedia call screening service. In: Short papers companion proceedings to LNCS 3744: Springer-Verlag . ISBN 2-553-01401-5. pp. 21-25

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Some relevant products / standards

Bubble talk (Digi, Malaysia, Telenor Pakistan ..) BubbleTalk TM is a "click, talk and send" Short Voice Messaging Service.

It's a "talk and listen" messaging alternative to the "type and read" service provided by SMS. (proprietary solution)

http://www.digi.com.my/data_services/messaging/datamsg_bt_faq.do Relating to the study ”Push-to-Talk Social Talk” by Woodruff and Aoki

(2004), but some different features though. Both Bubble talk and PoC may be used for professional field workers

Push-to-talk over Cellular (PoC) semi-duplex (’talk or listen’ / walkie-talkie-like)

Over WLAN/GPRS/... Over TETRA incl. *group communication* Ericsson, Motorola, Siemens, Nokia, “Push-to-talk over Cellular (Poc) specification”

(from Aug. 2003, i.e. old version)) input to etsi http://www.ericsson.com/multiservicenetworks/distr/PoC_specifications.ZIP

SIP and IMS of course

OSA of course

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GROUP AGENT SYSTEM

GroupManager: Groupname, address, user’s group

GroupAgent: Groupname, users, access to update

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GROUP AGENT

UserSession: Real-time messaging, context-information

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USER AGENT

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USER AGENT SERVICE

GroupService: Exist when user subscribe on group services

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GROUP SERVICE

GroupSession: Updating user session with context information, routing of messages

Administration: Administrative privileges