Residential Health Information Technology Systems (RHITS)

Cross-Industry Working Team

Charles N. Brownstein

Corporation for National Research Initiatives

3/11/03

Introduction

The Cross-Industry Working Team is forming a program of cross-sector collaboration to explore technology innovations to facilitate individual long-term health maintenance, and to understand ways in which this domain will affect future residential information technologies and services.

The program focus is on information processing and service provision in residential settings, communications for care assistance (informal and formal) from outside of the residence, and systematic interactions with medical services organizations and care providers.

This is a problem-rich application arena in which to explore socio-technical accommodations to facilitate existing practices and ways to meet new requirements.

Membership in the Working Team and participation in the program is invited of technology and communications suppliers, service providers, health care, government, and research institutions.

Domains of Study

Technology and Services Infrastructure

One domain is the future content and technology environment of ubiquitous information processing. In this application the environment must comprise a heterogeneous mix of inexpensive, reliable, efficient, adaptable devices and services as well as content. To be viable in application and in the marketplace, it must be sufficiently compelling to motivate individuals to employ new technologies for their own purposes. It must be appropriately linked to formal and informal support systems.

Along with speculation, there has been significant experimentation with notions of ubiquitous computing, the promise of wireless devices and visions of the "smart home". Still, the information processing capabilities, utility and "social feasibility" of this domain are uncharted. They are as unimaginable today as was the Internet of the 80's before the browser, search engines, flexible access and ever more inexpensive and powerful computing devices.

Given the scale of pre-existing residential infrastructure, an essential challenge is to determine ways in which the required technology can be as readily inserted into existing settings as have been radio and TV, telephony, computers and Internet access. Lessons learned in this study will inform the evolution of the residential information technology marketplace, and be generally extensible to similar environments.

The application domain of study is health maintenance for chronic medical conditions. There is a growing requirement for non-medical and quasi-medical services to aid individuals to better meet this need. This comprises myriad means of information-based assistance to promote effective self-care and assisted-care behaviors that are not feasible, economic, or otherwise desirably provided uniquely in the formal health care setting.

It is almost impossible to imagine today a future health services system that can meet the enormous requirements of the rapidly aging population. One set of challenges in this domain is to characterize and integrate non-institutional support mechanisms with health care and assisted living systems. These may involve family, friends, and community resources, and other information providers (public and private) and the paying system.

Lessons learned in this study will inform the evolution of the health care support systems and marketplace. They will be extensible to environments with similar functional requirements, including institutional, military and informal care assistance circumstances such as emergency care in natural or man-made disasters.

Program Activities

The programmatic activities are threefold. The first is collaborative research among the essential players in this arena to generate cross-sector understanding and consensus about technical and organizational requirements and solutions.

The second is to identify new R&D needed to solve problems and test solutions.

The third is to model initiatives for the private and public sectors to realize potential opportunities within the decade.

Motivation

Future volumes and duration of care will outstrip the present system’s service and financial capacities. Thus, health maintenance demands socio-technical innovation. From the point of view of health care providers, new ways of servicing clients are needed that facilitate individual initiative in health maintenance. Independently from their membership in heath maintenance institutions, aging individuals need to be empowered with better ways to manage their health. In both cases people benefit from the reinforcement of initiative, responsibility and satisfaction of attending personally and privately to their own needs and the needs of family and friends.

The formal "system" of medical services providers, insurers, employers, and the government needs ways to support the management of continuing non-emergency care in particular, both to reduce cost by providing services effectively and efficiently and also simply to support larger numbers of clients. Such methods must cover a broad spectrum, from today's dominant practice of providing instructions with recommended behaviors, to the potential integration of information infrastructure components such as micro-scale sensing devices, wide area networks and intelligent information services.

There are substantial benefits in understanding the resulting information technology, medical, social and economic issues and opportunities. Growing public and private sector interest, economic necessity and the influence of the aging population make health care a major policy arena and a growing market for technologies and services. More specifically, population demographics (the growing age 65+ population), combined with modern health care outcomes, will generate a sustained requirement for long-term self-care and facilitated support for people with chronic problems such as diabetes and congestive heart failure, among others.

Adequate long-term maintenance care cannot be met by the professional health care system by traditional methods of care under any present economic or social scenario. A societal requirement of this scale will grow demand to facilitate self care support.

In fact, most of the required maintenance care does not require professional attention. It is more appropriately based in the residence with an extended support infrastructure of people, technology and information. Information technology applications that employ new inexpensive computer structures such as communicating sensors and low cost information processing devices in economically and functionally scalable ways will be major components of the enabling infrastructure.

With growing demand, there will be opportunities to create new services offerings to meet the demands of private individuals, health care providers payers and the government. Many technologies and services will compete in the health care maintenance marketplace. All will benefit from the sort of standards-based infrastructure that the Internet provides. Thus, this project seeks to assess what standards or sets of standards ought to support a suitable infrastructure.

The Opportunity

Meeting the problems of facilitating health maintenance will also create an expansive market for enabling technologies accessible information technology and service innovations. The solutions identified will generate understanding of how to integrate and employ emerging information processing technologies, sensors, computing structures, displays, communications networks and information management software in the hypothetical "ubiquitous computing" environment of private residences and residential institutions. Knowledge gained from understanding this environment will define the means for assessing other information processing applications that share the residential infrastructure.

Health care information is accessed from the Internet by growing numbers of people. Care providers employ the web for a variety of relationship purposes. Institutions such as the National Library of Medicine and a variety of commercial sources provide substantial information to the public. Still, health care as a social requirement requires innovation far beyond today's Internet/Web concepts and capabilities.

The innovations under study in this effort require capabilities that cut across the device, network and information spectrum, but in edge environments. These will require innovation and represent new opportunities for communications, computing, software, hardware and information services providers. The greatest opportunities for innovations are in information technology applications that combine new computing structures such as inexpensive sensors and processing devices with robust communications capabilities linked to high capability information processing and wide area communications in economically and functionally scalable systems.

This infrastructure will enable new classes of economical health care maintenance and support services across a broad spectrum. At one end are information services for self/patient provided assistance and informal social support. At the other end is close-coupled interaction between patient and professional medical personal.

The growing demand will create opportunities for new services offerings to meet the demands of private individuals, care providers, payers and the government. Information technology applications will be the enabling infrastructure. Many technologies and services will compete in the health maintenance marketplace. All will benefit from the sort of standards based infrastructure that the Internet provides.

The scenario for analysis is to enable and support individuals in their own maintenance care rather than directly burden the formal health care system. The specific requirement is to systematically facilitate assistance in care by non-medical professionals such as friends, family and new specialized service providers. Such "enabling systems" may stand alone, be integrated as health technologies, products and services, or be shared with other residential information processing applications.

Exploring them from the health care point of view, with stringent requirements for reliability, safety and ease of use, will reveal opportunities to shape the residential information technology infrastructure. It will also stress thinking about the broader social and policy issues of the future ubiquitous computing environment.

Representative Technical Dimensions

Communications systems

(1) Integrated transport of appropriate data types;

(2) Management/usability attributes are user controlled or remotely managed, low maintenance, stand alone);

(3) Self-configuring networks, composed, integrated and interoperable with accessible telecommunications, computing, entertainment and other enabling appliances and services.

Sensing, data generation and display systems

(1) Heterogeneous, "aware" systems of devices appropriate to obtaining and maintaining data and evaluating states with minimal intrusion (e.g., from environmental and individual's physical states, behaviors, medication inventories, and other inputs);

(2) Methods of information management, aggregation, analysis, access display and presentation in ways appropriate to requirements of the target individuals in their residences, non-professional and professional care givers and the health care industry.

Scaling and maintenance systems

(1) Standards appropriate to technology, scale economies, application stability, regulatory, liability and health system integration;

(2) Service life and reliability, ease of use, portability, safety and Quos;

(3) Provision of and access to facilitating information products and services, (including health care regulatory considerations);

(4) Distributed operations, management, accounting and billing.

Representative Social and Economic Dimensions

Viability

(1) Affordability, understandability, controllability, manageability (including configurability, serviceability, and fit to socio-economics of health care;

(2) Safety, reliability and overall security including privacy protection information management and user controlled and automated data generation and diffusion, locally and in the health care system;

(3) Trustworthiness, validity, flexibility, control over the way information is combined, standards for measuring and interpreting user subject’s state;

(4) Flexibility and adaptability for residence and user variability, individual and multiple users with mixed capability and potential interaction with system(s);

(5) Ubiquity, environmental compatibility, aesthetics and cost.

Integratability

(1) Fusion of behavioral, health and other relevant data

(2) User understanding of, comfort with and ability to function with system technology and information;

(3) Ease of integration of the "personal information" segment into other segments of health care system;

(4) Ease of integration of personal health maintenance technology and content system components with other residential technology (e.g., other entertainment, home automation, communications and computing systems).

Program Outcomes

Informed Consensus

Project activities will generate informed consensus views of technical requirements and specifications for a future IT infrastructure applied to residential health maintenance care. These will detail the relationship to and requirements for the more general residential information technology infrastructure. They will lay out a practical vision and options for future residential and wide area telecommunications. The project will place the technical vision into appropriate social and economic contexts identified by expert peers with a variety of skills and motivations, collaborating to inform themselves in the interests of their organizations.

Vision

In addition, information will be diffused that could be useful for health care planners, public policy makers and for members involved with the one or more of the future health care, residential information infrastructure, computing and communications markets. As appropriate, the project will develop public documents presenting a national initiative to policy makers, industry and the public. It will provide a long term R&D agenda for this application arena and a road map for government and industry R&D investment.

Plans and Initiatives

The project will create plans and proposals for joint R&D projects among members or for the organization. Such plans will be of significant utility for the IT, medical, services and public sector organizations. Given the scale and scope of the required R&D, the working team will generate and submit proposals for program and project funding and submit them to federal R&D funding organizations in DOD, NIH and NSF. The goal will be to obtain support for experimental research in the technical and application areas outlined herein.

Responsibilities

Participants will designate organizational representation to contribute actively to the project, attend team meetings (physical and virtual), and engage in discussions and preparation of documents as appropriate. Participants are responsible for collectively providing project resources, setting overall project directions and policies. CNRI will act as Secretariat, facilitating participant interaction and undertaking project administration. CNRI will participate as a partner in substantive and planning discussions, lead preparation of public documents and communications, and as appropriate organize, manage and participate in the conduct of research pursuant to project goals.

Participation

Participation is open to members of XIWT and their guests. Membership is open to companies, public and private institutions with interest and roles in the domains outlined above.

Please direct inquiries to Charles N. Brownstein.

email: cbrownst@cnri.reston.va.us; tel: 703 620 8990.