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On the Coming “Everyware” Bubble in Health Care

by Fred Fortin

Last week AT&T Inc. announced it is now selling “a complete portfolio of radio frequency identification (RFID) tracking offers for health care providers. The RFID solution will enhance visibility into the operations of hospitals and other health care facilities.”

“The company is offering the devices, infrastructure and systems needed for full-scale tracking applications — everything from tags and software to networks and data storage”. . .providing “a Wi-Fi-enabled location-based service to track equipment, devices and patients. . .”

In an interview with Tim Cunningham, Director of RFID development at AT&T, specific solutions for their customers would differ since “it all depends what is being tracked, and whether that includes patients or not,” he said. Intel’s Director of Research, Andrew Chien, speaking at the MIT’s Emerging Technologies Conference this week, talked about “terascale computing”. Chien is looking at how to use these future machines.

“One of the things we’re very focused on is this idea of inference and understanding the world. The big idea is all about this question of whether inference and sensors are really the missing piece to make ubiquitous computing come to fruition.”

Ubiquitous Computing (pervasive computing, physical computing, tangible media) or “Everyware”, as critical technology futurist Adam Greenfield describes it, is here. Today. And while the promoters of Health 2.0 feel there is gold in “them thar hills”, but are still looking around for a business model, ‘everyware’ developers are already mining the health care industry’s deep pockets who, in turn, are being driven by a number of more immediate concerns such as patient safety and cost.

So what is ‘everyware’ when it comes to health care? Well, let’s take something we are starting to get a handle on, Electronic Medical Records (EMR). We’ve already mentioned the evolution we see happening towards an intelligent EMR (see earlier post).We now think of the EMR as a snapshot of someone’s medical history and current status. What if the EMR was more of a movie instead: a continuous, real time flow of information from the source, the patient’s body, to an intelligent networked system geared to flag critical indicators and thresholds and whatever else, for that matter, that needs monitoring?

Medical vigilance technologies, for example, hook up the body’s formidable medical information production capabilities to wireless, networked and intelligent systems — whether you’re in the hospital, at home or on the go. Tracking technologies can also tell where you are, or have been, in each of those settings as well.

For hospitals, tracking applications, like that of AT&T, can both save lives and money. Beyond knowing instantly where emergency personnel and equipment are, for example, surgical teams can track things like sponges or instruments to ensure that nothing is left in places where they not ought to be.

For our growing population of elderly, wearable biometric devices, voice and gesture recognition interfaces, memory augmentation systems — all these may be essential (and cost-effective) tools in managing future complex health conditions while maintaining as much patient autonomy as possible.

Along with intelligent bathtubs, toilets, beds, refrigerators, rooms, and entire homes — literally anything that can be “colonized” by sensors, or “ambients”, which wirelessly port information over to an intelligent network — ‘everyware’ is slowly insinuating itself into what we can call “smart” health care.

The convergence of these technologies — RFID, ultra-wideband, and IPv6 (new internet protocol) — pointed at the needs of the health care industry, promises great advances in the convenience, cost and quality of care. But this promise also comes with great risks. Greenfield has pointed to many of these risks which can be easily transfered to what’s happening in health care. They include among other things:

  • the exponential expansion of “surveillance” (including medical surveillance)
  • the consequences of software/hardware failure
  • the psychological impact of former latent, unmeasured information being made ‘public’
  • the lack of awareness, or understanding, of being subject to these unannounced or invisible technologies
  • the unpredictability of how these technologies will act — think HAL 2001 here — when all are interconnected

These technologies will come to us piece by piece, with the impact being a slow emerging boil, rather than a full and obvious onslaught of a total inter-connected system being thrust upon us. But the speed, storage, addressing, display, wireless, and technical standards for these systems already exists. That means ‘everyware’ is already a reality for some.

Yet thinking about these technologies holistically will be difficult. And according to Greenfield, it’s not sufficient simply to say “First, do no harm”. He advises that we take the time now to deliberate on the human consequences of all this and start to think through the social rules of the game. In that light he poses a few principles to be considered.

  • Everyware must default to harmlessness
  • Everyware must be self-disclosing
  • Everyware must be conservative of face
  • Everyware must be conservative of time
  • Everyware must be deniable (opting out)

The recognition of these principles, along with educating ourselves on these new technologies is the starting position. The race will be long. The outcome will determine, as Greenfield observes, whether we’ll “develop an everyware that suits us, as opposed to the other way around.”


[…] my entire post over at the World Health Care […]

  Onehealthpro wrote @ October 1st, 2007 at 10:12 am

Whatever happened to health care organizations developing a strategic plan that allowed them to move in a systematic fashion to address issues? Willy nilly leaps into this and that without considering options and implications of all options has led to chaotic systems that are barely negotiable by the patients whom these systems reportedly serve.

  Renata wrote @ October 1st, 2007 at 2:02 pm

Like the “Hal 2001″ analogy. Hope we don’t have an Iraq-like government driven vendor feeding trough, where the needs of consumers (patients/caregivers) don’t (again) get trumped or, end up at the bottom of the totem-pole — very expensively, of course. Iraq and Katrina have demonstrated what can happen when the needs of consumers/tax payers are usurped by tech cos. and the conflicted interests with the medical/clinical establishment(s). Thankfully, as consumers (patients/caregivers) assume a peer role beyond paying ever increasing bills or leaving the system altogether due to lack of affordability — in their own healthcare matters — SOME breaks and thought will be added to the mix. It is badly needed. The status quo is a direct result of lack of accountability to the ultimate consumer/tax payers — who are being pressed from all directions to their detriment. — with no end in sight - and no real advocate. GoogleHealth, Yahoo!Health, RevolutionHealth, etc. are to be admired for providing a platform for self-education and utilities/tools to begin the process of consumer education/MANAGEMENT to correlate with the financial pressures and increasingly complex responsibilities consumers must assume.

[…] a previous post on the “everyware” revolution in health care, I argued, that we’ve come to think of the Electronic Medical Record (EMR) as […]

  More Reports of Patients Tracked with RFID « ajfortin.com wrote @ October 10th, 2007 at 10:06 pm

[…] seeing examples of the emergence of medical “everyware” being announced in the press (see my earlier post). In the first case, it’s dementia patients in Luxembourg being tagged. From E-Health Europe […]

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