Design and Implementation of A Virtual Assistant for Healthcare Professionals Using Pervasive Computing Technologies

The goal of pervasive health care is to provide healthcare services to everyone at any time overcoming the constraints of place, time and availability of doctors, nurses and resident doc

Design and Implementation of A Virtual Assistant for Healthcare Professionals

Using Pervasive Computing Technologies*

Sheikh I Ahamed, Moushumi Sharmin,

Shameem Ahmed, and Munirul M Haque

Marquette University, Milwaukee,

Wisconsin, USA

{iq, msharmin, sahmed02, and

Ahmed J Khan Assistant Professor of Medicine

Medical College of Wisconsin, Milwaukee,

Wisconsin, USA

akhan@mail.mcw.edu

Abstract

With the advancement of hand held devices,

wireless and sensor network pervasive computing has

achieved a perfect momentum Formerly, a requirement

existed that was a serious impediment and threat to the

mobility of users the necessary presence of a fixed wired

network This has been resolved by the recent advances in

wireless and mobile technologies, particularly Bluetooth

and WiFi The advancement of available, portable, low

cost mobile devices (PDAs, cell phones, etc.) has resulted

in the user’s mobility at unprecedented levels As these

devices can communicate with one another, the combined

capabilities can be leveraged to form a useful new set of

tools Presently, pervasive computing is being extended

into the sophisticated healthcare sector with the promise of

providing an easier and more efficient mode of

communication between physicians and patients or

between the physicians themselves In this paper we

provide the details of our application ‘Healthcare Aide’,

which has been designed to provide not only more

convenience for doctor-doctor, resident doctor-doctor,

patient-doctor and nurse-doctor interaction but also a

smooth pathway for real-time decision making Our

pervasive middleware MARKS (Middleware Adaptability

for Resource Discovery, Knowledge Usability and

Self-healing) provides the underlying support for this

application in a completely transparent manner In this

paper, we have also presented our survey results from

users’ point view along with performance analysis

Keywords: Virtual Assistant, Healthcare Aide, Pervasive

healthcare, and MARKS

1 Introduction

Pervasive computing [18] is the concept that

incorporates computing in our working and living

environment in such a way that the interaction between

humans and computers becomes extremely natural, and the

user can get many types of data in a totally transparent

manner Considering virtual reality, which builds an

artificial world in the computer, at one end of the

spectrum, we can put pervasive computing, which embeds

computing in the real world at the other Along with the forward march of wireless and sensor networks, the demand curve has increased for PDAs, mobiles, smart phones, and other small hand-held devices, to reach exponential growth With that, pervasive computing is showing its potential in almost every aspect of our life including hospital, emergency and critical situations, industry, education, and hostile battle fields, to name a few The use of this technology in the field of health has been termed pervasive health care The goal of pervasive health care is to provide healthcare services to everyone at any time overcoming the constraints of place, time and availability of doctors, nurses and resident doctors

Healthcare professionals need information delivery tools for accessing information at the point of patient care

as well as transporting the information to other relevant sites Personal digital assistants (PDAs), or hand-held devices demonstrate great promise as point of care information devices A 1995 study on the use of PDAs at the point of care found that hardware constraints, such as memory capability limited their usefulness [28] Since this study was completed, over the last 10 years, hand-held computer technology has advanced rapidly, and as of 2001 and 2002, between 26 and 50% of physicians used PDAs [29] ACP-ASIM survey finds nearly half of U.S members use hand-held computers [30] This use appears higher among residents, with one recent study finding that over two-thirds of family practice residencies use hand-held computers in their training programs [31] Results of another survey and follow-up interviews on 88 residents in seven programs showed most residents use PDAs daily, regardless of practice or whether their program encourages PDAs Uses include commercial medical references and personal organization software, such as calendars and address books The results of this study suggests improvement needed in (a) providing secure clinical data for the current patients of a given resident, and (b) allaying concerns of catastrophic data loss from their PDAs (e.g by educating residents about procedures to recover information from PDA backup files) [32] However, Handheld personal digital assistants (PDAs) have undergone continuous and substantial improvements in hardware and graphics capabilities, making them a

*This is an expanded version of a short workshop paper on our initial work The initial work has been accepted to present in 1st Workshop on Ubiquitous and Pervasive Health Care (UbiCare 2006) of Fourth Annual IEEE International Conference on Pervasive Computing and Communications (PerCom 2006)

compelling platform for novel developments in high space

occupying usage including even teleradiology The latest

PDAs have processor speeds of up to 400 MHz and

storage capacities of up to 80 Gbytes with memory

expansion methods A recent paper by the department of

emergency medicine at University of Alberta, Canada

shows that availability of bedside computer facility helped

physicians to access information at the bedside and

increased the use of Clinical Practice Guidelines Decision

Support Tools The patients also appeared to accept their

use of information technology to assist in decision making

[33] Inpatient healthcare delivery involves complex

processes that require interdisciplinary teamwork and

frequent communication among physicians, nurses, unit

secretaries, and ancillary staff Often, these interactions are

not at a nursing unit, or near a phone A study was

conducted at the St Agnes Hospital in Baltimore, MD

regarding any potential benefit of wireless communication

devices The results identified a number of significant

findings that demonstrate a healthcare benefit from a

quantitative and qualitative standpoint [34]

There are a number of research projects [3-14] at

various universities and research institutes related to

pervasive healthcare In the CodeBlue project [12] at

Harvard University, the researchers tried to provide an

ad-hoc wireless infrastructure as a solution to a medical

emergency situation Using low power sensors (for

providing vital data) and PDAs this project will assist the

team of clinicians involved in the management of the

emergency to communicate and share data more efficiently

and also help in decisions making In the WWM (Wireless

Wellness Monitoring) project [3] a behavioral feedback

system was implemented using some monitors, PDAs and

a home server forming a WLAN (Wireless Local Area

Network) In the CASCOM project [4], researchers tried to

provide real-time solutions in the tele-medicine sector

using mobile devices Several application projects,

working to satisfy various concerns or segments of the

healthcare sector, are going on in Denmark’s ‘Centre for

Pervasive Health Care’ [5]

In teleradiology a new technology has emerged to

interface Picture archiving and communication systems

(PACS) and PDA PDA-based teleradiology has the

potential to increase the efficiency of the radiologic work

flow, increasing productivity and improving

communication with referring physicians and patients [35]

For its new acute care hospital, the University of

California at Los Angeles is evaluating innovative

technology involving high-resolution flat panel display

devices configured as "network appliances" that can be

wall mounted for use in the retrieval and display of

medical images and data Physicians and healthcare

providers can log on with wireless handheld computers,

which can serve as an identification device as well as a

navigational tool for selecting patient records and data

These data are displayed and manipulated on the flat panel

display without the need for a keyboard or mouse A prototype was developed with commercially available image display software, which was modified to allow the remote control of software functions from a handheld device through an infrared communication port The system also allows navigation through the patient data in a World Wide Web-based electronic patient record This prototype illustrates the evolution of radiologic facilities toward "shareable" high-quality display devices that allow more convenient and cost-effective access to medical images and related data in complex clinical environments, resulting in a paradigm shift in data navigation and accessibility [36]

For physicians, wireless connected hand-held computers are gaining popularity as point of care reference tools The convergence of hand-held computers, the Internet, and wireless networks will enable these devices to assume more essential roles as mobile transmitters and receivers of digital medical Information In addition to serving as portable medical reference sources, these devices can be Internet-enabled, allowing them to communicate over wireless wide and local area networks With enhanced wireless connectivity, hand-held computers can be used at the point of patient care for charge capture, electronic prescribing, laboratory test ordering, laboratory result retrieval, web access, e-mail communication, and other clinical and administrative tasks Physicians In virtually every medical specialty have begun using these devices in various ways [37] Communication capable PDA has also made healthcare very versatile and mobile Carrying hundreds of patient files in a suitcase makes medical street outreach to the homeless clumsy and difficult Healthcare for the Homeless Houston (HHH) began a case study under the assumption that tracking patient information with a personal digital assistant (PDA) would greatly simplify the process Equipping clinicians with custom-designed software loaded onto Palm V Handheld Computers (palmOne, Inc, Milpitas, CA), Healthcare for the Homeless Houston assessed how this type of technology augmented medical care during street outreach to the homeless in a major metropolitan area Preliminary evidence suggests that personal digital assistants free clinicians to focus on building relationships instead of recreating documentation during patient encounters[38]

In this background, a lot of work is going on in researching to make PDA more efficient in meeting the ever increasing need of the medical professionals All the existing and ongoing projects try to build a bridge between service providers (doctors, nurses, or paramedics) and some kind of external events (like a patient at home, emergency situations at some place, etc) In this way, technology is used to increase the interaction between patients and doctors, assisting service providers by giving them needed information In our approach, we have tried

to use pervasive computing technologies for situations that

occur at he medical center We have incorporated this

technology using PDAs for information sharing in

emergency decision making situations This will also

provide a means for patients to more fully participate with

their physicians in managing their healthcare This project

will also provide a smooth pathway for better continuity of

care for the patient, as well as a smarter doctor-doctor

interaction These benefits will, in turn, create a safer

health care delivery system with reduced chances of

medical error A more efficient learning environment for

the trainee physicians or medical students will be created

Our main focus areas are the sign out, endorsement,

consultation or other patient related communications that

go on constantly among the physicians and other

healthcare professionals such as nurses, resident doctors

working in-house Our approach tries to adopt this

promising technology in such a way that it maximizes the

use of limited hospital resources, while at the same time

creates a faster 21st century communication portal among

the in-house physicians

To provide support for our application, a middleware

named MARKS (Middleware Adaptability for Resource

Discovery, Knowledge Usability and Self-healing) [2, 20,

and 22] has been developed Along with several core

services, it ensures the services of Knowledge Usability

[19], SAFE-RD [21], Ubicomp Assistant Service [25], and

GETS Self-healing [23] From a user’s perspective,

MARKS provides these services in a ubiquitous and

transparent manner Some preliminary work has been

presented in [27] In this paper, we have presented the

details of our application along with extensive survey

results

Several scenarios are depicted in section 2 where our

‘Healthcare Aide’ provides the perfect solution Section 3

describes several healthcare projects with related goals

Characteristics and challenges are discussed in Section 4,

and functional requirements of ‘Healthcare Aide’ are

reviewed in section 5 How ‘Healthcare Aide’ adheres to

the required characteristics is presented in section 6

Graphical representations showing the placement of

MARKS and ‘Healthcare Aide’ and some screen shots of

the prototype have been added as supplements Section 7

deals with how to use ‘Healthcare Aide’ The evaluation

details have been portrayed in section 8, which is followed

by conclusions and future directions in section 9

2 Motivation

Scenario 1

Dr Jones, a resident doctor in a hospital, has

fourteen patients in his care and he needs to sign out

detailed information about all of his patients to his on-call

colleague Dr Smith Normally, Dr Jones would have to

use the telephone to give verbal sign-out instructions for

Dr Smith to write down Or he would retype all the patient

information from his hand-held device and somehow make

it available to Dr Smith electronically Now with

“Healthcare Aide”, Dr Jones can simply and with little effort transmit his patients’ data from his handheld device

to Dr Smith who is working somewhere else in the medical center While observing the patient, Dr Jones took some notes and in the evening when he leaves, new doctors will take charge Before signing off, Dr Jones needs to inform the evening shift doctors of his findings

He makes his observations and comments about the patients available to the associated evening shift doctors instantly and effortlessly with the use of Healthcare Aide

Scenario 2 Suppose a senior medical student was performing his

duty in the Intensive Care Unit (ICU) Suddenly he noticed something unusual for a particular patient The medical student was not familiar with the symptoms and was not sure about whom to consult or how to manage the situation He broadcasted a message containing the symptoms so that all the available in-house residents and other senior medical students received his message One of the doctors, Dr Morrice, understood the situation and could respond on the fly via his PDA The medical student had followed the recommended procedures Within a couple of minutes Dr Morrice reached the ICU and took charge Within this small passage of time, medication was able to be quickly administered which may have saved the life of the patient

Scenario 3

Ms Becky has been admitted in the gynecology

department of a medical center for some complex problems, the exact etiology of which is still unclear She was under the care of Dr Fin, who had prescribed medication However, the patient wants to consult with other physicians about her condition In situations such as this, rather than calling up various physicians from different sub-specialties in search of the right physician, a palm device can be used to broadcast patient information

to the PDAs of all other physicians; this would save time and cause little inconvenience Both Ms Becky and Dr Fin could get help in a timely manner

Scenario 4

In a code blue [12] scenario, doctors are running from

all over the hospital to attend a cardiac arrest patient While the response team is on its way through the hallways or elevators of the medical center, the resident taking care of the patient sends a brief PDA broadcast containing important medical information about the patient now in cardiac arrest In this way, the response team will have immediate knowledge of the patient’s condition and not waste valuable life-saving time trying to find the patient’s medical data after arriving at the code blue scene

A similar scenario has also been depicted in one of our papers [25] Situations like these require the need for

applications that can assist doctors in their work and

ensure patients can get emergency help when needed

Figure 1:

Medical Application for Doctors

The fast-paced, highly mobile environment of a

hospital provides a situation whereby mobile technologies

and applications can be very valuable Presently, wireless

devices are employed in hospitals for purposes ranging

from accessing test results to completing administrative

tasks such as admitting patients [1]

However, this environment also provides a situation

where information security is of paramount importance

due to the highly sensitive nature of the information being

transmitted For example, each morning resident doctors

meet for their morning rounds to discuss the conditions of

patients This meeting could be improved by allowing

medical records and notes to be transferred from one

resident doctor’s device to another’s or to a community of

devices In such an application, security is extremely

important A highly secure and trusted mechanism must be

employed to ensure malicious entities do not obtain

exceptionally sensitive data such as test results or personal

information In figure 1, personal information of patient B

and a test result of patient A are being transferred from one

doctors’ PDA to another This requires highly secure

transmission Information is personal and confidential in

this area and demands extensive support for maintaining

privacy and security In the first scenario, information

about a patient is transferred which needs a secure

transmission so that no information leak occurs in any

point In the second scenario, response from authoritative

doctors should be considered The patients’ privacy and

security both play a vital role here In the third scenario, as

a better alternative approach, the patient could open her PDA

and check the list of doctors that ends with ‘gyn’ (a suffix

which indicates they are gynecologists) Now she could

broadcast a message or chat to one/all of them about her

problem and instantly select a doctor and make an

appointment with him/her This will not only simplify her

effort but also allow her to communicate with more doctors in a very condensed timeframe

3 Related works

In a workplace study at IMSS General Hospital in Ensenada, Mexico, researchers developed a context aware mobile system for the hospital environment [6], [7], [8] using Jabber open-source IM (Instant Messaging) server and a corresponding XMPP (Extensible Messaging and Presence Protocol) But the use of fixed infrastructure like

an IM server, the database for hospital information is restricted in use just inside the boundary of the hospital Our application, however, is running completely on an ad hoc network without using any kind of fixed infrastructure

As a result, the active region of this application has been extended beyond the sphere of a hospital building In [9], [10], and [11], privacy issues of the public displays were discussed, as well as persons involved in the day-to-day hospital work like doctors, supervisors, or medical interns Our approach was to address the privacy of the data being shared We adopted a specific encryption technique to protect the privacy of data Along with that, this application provides an authentication mechanism to ensure that the sophisticated medical information is only being seen by authorized personnel

In the CodeBlue project [12], [13], [14], a small, wearable wireless pulse oximeter and 2-lead EKG based

on the Mica2 [15], MicaZ, and Telos[16] sensor node platforms have been developed Also being developed is a scalable software infrastructure for wireless medical devices However, their approach is different from ours They are deploying the sensor network concept which makes their system heavyweight while we have tried to make this system lightweight as well as efficient from a power, monetary, and performance standpoint

In the ‘Centre for Pervasive Health Care’ in Denmark, several health care projects like the AWARE project, the ComPUTE project [5], Medical Visualization and Simulation (MedVisSim) are using sensor networks and pervasive computing technology In their application

‘Pervasive Computing for Acute Medicine’, they tried to build a solution for critical and emergency situations involving emergency vehicles, dispatch centres and hospitals They are trying to communicate information and generate graphical representations of information gathered through biomedical and other sensors Our approach tries

to assist the doctors directly through information and file sharing without using any external objects, permitting a more direct, resource-efficient solution

The scientists at University Rey Juan Carlos, Madrid are working on a project named CASCOM (Context-Aware Health Care Service Co-ordination in Mobile Computing Environments) [4] CASCOM is being implemented with the goal of providing ‘on the fly’ assistance in medical emergency situations Organized into

three layers, CASCOM will provide generic and secure

decisions in the field of tele-medicine However, they are

developing this infrastructure for mobile and fixed

networks We tried to make our system as free from any

infrastructure as possible The dependency on a fixed

powerful network is eliminated in our approach

4 Characteristics of the Healthcare Aide

c1) Privacy aware seamless service capability

The system can be used by anybody in any situation at

any time It will present itself as an omnipresent service to

the user At the same time it will ensure privacy of

information through its security mechanism, thus reducing

the probability of malicious use of the highly confidential

and personal information

c2) Continuous connectivity

The system has to ensure persistent communication

between the connected devices It has to guarantee proper

connectivity unless any of the users disconnects his/her

device manually

c3) Energy efficient

Battery power consumption places a real constraint on

mobile applications ‘Healthcare Aide’ handles this

constraint with maximum care that has been proved by the

graph shown in figure 5

c4) Zero negative impact

One primary goal of any application is to ensure that it

doesn’t have any negative impact on the performance of

other applications running on the specific device Our

application not only ensures this but optimizes the overall

performance by minimal use of battery power and memory

storage

c5) Tiny memory footprint

Due to the common memory constraint of the mobile

devices, it is nearly impossible to synthesize an application

with all possible features while still capitalizing on tiny

storage capacities This application perfectly incorporates

the well-known characteristic for pervasive software:

miniature form

c6) Cost effectiveness through mobility

Cost efficiency is another crucial aspect of mobile

applications As our system is working on ad-hoc devices

without the help of any fixed infrastructure (such as a PC,

a mainframe, or a central server), the cost has been

significantly minimized

c6) Concurrent applications

In our application, one user can run more than one feature at the same time, thus incorporating the characteristic known as ‘parallel processing’

c7) Secure Service Discovery

In a wireless sensor network, a device like a PDA searches for other similar devices and discovers them This

is one of the major goals in building a distributed wireless network But this goal, known as ‘service discovery,’ is just not enough Each PDA has to be able to discover neighbors who are ‘secured’ and be able to communicate only with these ‘trusted’ friends.

c8) Secure Communication

As file transfer and information sharing are the two most

important features of this system, this communication

procedure has to be absolutely sealed from intruders

c9) Authentication There has to be some kind of authentication procedure which can identify the correct user and protect the system from being used by any intruder

5 Functional Requirements of Healthcare Aide

Requirements from the resident doctor/doctor’s point of view

1) There is a pre-specified form so that the resident doctor can easily keep all the necessary information about the patient

2) The doctor can take any additional notes on a patient

if he/she wants

3) A doctor can easily send all the information (or some selected information) to as many people as he/she wishes

4) Except for the designated authenticated doctors, no one can access the database containing patient data 5) During transfer of the patients’ information, it is compulsory to communicate wirelessly in such a way that any intruder will not be able to get the information (e.g encrypt the file)

6) Normally the doctor writes down the information on paper The doctor may enter that data in the database later This two step system should be merged in such

an efficient way that if the doctor writes to his/her device (similar to writing on paper), it would automatically be saved in the database

7) There should be a way to save all the sign-out transactions over the past one year or more in a stable storage device like a desktop or other server This information can be used for future patient care needs, for research or billing purposes, or medico-legal reasons

8) A doctor may want to chat with other doctors

Requirements from the medical student’s point of view

9) Medical students will be able to download files from

the instructor/doctor, provided the instructor/doctor

agrees to share each file The file might be any type

(docs, images, pdf, voice files, video files, etc.)

10) They will able to share an interesting rare case with

other students in the medical center

11) Communicate with other students about any change in

their lecture schedule, by broadcasting a message to

all the students scattered throughout the hospital

Requirements from the \nurse’s point of view

12) Nurses will be able to download files from the doctor,

provided the doctor agrees to share each file The file

might be any type (docs, images, pdf, voice files,

video files, etc.)

13) They will able to share an interesting rare case with

other students, doctors and resident doctors in the

medical center

14) Communicate with other nurses about any change in

their schedule, by broadcasting a message to all the

nurses, doctors scattered throughout the hospital

6 Development of Healthcare Aide using

MARKS

How Healthcare Aide adheres all the characteristics:

‘Healthcare Aide’ encapsulates all of the characteristics

mentioned in section 5 Some of the characteristics are

supported by ‘Healthcare Aide’ itself, whereas the rest are

provided by the core services

Figure 2 MARKS Architecture [2, 22]

‘Healthcare Aide’ incorporates the characteristic

‘privacy aware seamless service capability’ (c1) Provided that the wireless connectivity is available, it places itself in

an ‘all-time ready’ service state that is available to serve whenever the user wants

The core services of our middleware (MARKS) support the characteristics ‘continuous connectivity’ (c2),

‘concurrent applications’ (c6) and ‘secure service discovery’ (c7) In accordance with c6 someone can give the command for transferring a file while he/she is chatting A special ‘key’ feature has been introduced to achieve ‘secure service discovery’ (c7) When a PDA will try to discover its neighbors, it will broadcast a special packet, and this will be recognized and responded to only

by those trusted devices that have that predefined ‘key’

In section 8.3 we provided a detailed graphical representation in order to prove that this tool is really

‘energy efficient’ (c3) and complies with the ‘zero negative impact’ (c4)

In order to comply with the memory storage constraints

of PDAs, ‘Healthcare Aide’ captures only a small portion

of memory This fact – ‘tiny memory footprint’ (c5) is illustrated in the following table:

Table 1 Code size of Healthcare Aide

Lines of code file size (KB)Executable

Our tool doesn’t use any costly and comparatively heavy fixed infrastructure, and rewards itself with cost minimization (c6) Since several devices can join and leave arbitrarily at any time, an ad-hoc wireless infrastructure is very crucial and is conveniently supported by MARKS When we transfer a file containing secure and sophisticated information, that file is transferred in encrypted form At the destination end, receivers only with the decryption mechanism can read the file Again MARKS has a vital role in merging this characteristic (c8)

At present we are providing a heavily used password based authentication system to ensure this characteristic (c9) But we hope to give more time and effort in the future to this field, which is discussed in section 8

7 How to use Healthcare Aide

The necessary hardware and software requirements for proper functionality of Healthcare Aide are as follows:

1 Hand-held devices (for example Dell Axim X50v PDA) with Windows CE operating system

2 Wireless card (Bluetooth or IEEE 802.11b)

Operating System

MARKS

Core Service

[Providing transparency over ad hoc

communication]

Application Objects

Self-healing

Security

Service Assistant Service Ubicomp Healthcare Aide

Knowledge Usability Resource

3 MARKS [22]

To run ‘Healthcare Aide’ the following steps should be

followed:

 Install Healthcare Aide:

At the beginning, the user needs to install ‘Healthcare

Aide’ Like other NET compact framework references,

‘Healthcare Aide’ will appear as another supplementary

reference

 Establish the required wireless connection:

At this step the user has to ensure his/her connectivity

by setting up a wireless connection in the desired wireless

network that he needs to communicate When the wireless

connection is active, the device will automatically show

the wireless networks available in the vicinity When the

authentication procedure is over, the user can

communicate with other devices in that network with

appropriate access permission

 Run the middleware (MARKS):

Now the user needs to execute MARKS It will

perform all the necessary steps required to make the bridge

between the front end (Healthcare Aide) and the back end

(Windows CE)

 Execute the application:

In this conquering step, the user has to run

‘Healthcare Aide’ Now the user can avail himself/herself

of all the services contained in ‘Healthcare Aide’ by

choosing different options from the simple front end

8 Evaluation

We can evaluate in the following ways:

1 Implement a prototype

2 Cognitive walkthrough strategy

3. Performance measurement

8.1 Prototype implementation

We have designed and implemented the prototype of

Healthcare Aide We have used WINCE as the operating

system, a Dell Axim X50v as PDA hardware platform

(processor type is Intel PXA270, speed is 624 MHz,

display is 3.5" Transflective TFT color, and weight is 4.8

oz), VC#.Net Compact Framework as programming

language, mobile ad-hoc mode of IEEE 802.11b as

underlying wireless protocol, and SQLCE for database

support The screen shots of the prototype are shown in

figure 3

8.2 Cognitive walkthrough strategy

To get the proper assessment of our application, we

followed the cognitive walkthrough strategy [24], which

encompasses one or a group of evaluators to inspect a user

interface by going through a set of tasks to evaluate its understandability and learning curve

Chat with other doctors Requesting a file

Try to access a file patient record

Patient data has been saved Patient’s additional info Figure 3: Some screenshots of Healthcare Aide application

Characteristics:

We have used the following characteristics of cognitive walkthrough strategy (shown in Table 2) for Healthcare Aide:

Table 2 Characteristics of cognitive walkthrough

strategy

Applicable stages: design, test, and deployment

Personnel needed for

the evaluation

Users: Some resident

doctors and medical

professionals

Usability issues covered

Effectiveness: YES Efficiency: YES Satisfaction: YES

Can be conducted

remotely: NO Can obtain quantitative data: YES

Usability Issues: Men and Women

0.0

1.0

2.0

3.0

4.0

5.0

Overall Easy to use Easy to input interface

navigation

Women Men

Figure 4: Rating of Healthcare Aide by users (Men and

women)

Usability Issues in Different Age Span

0.0

1.0

2.0

3.0

4.0

5.0

Age<30 Age 30-50 Age >50

Figure 5: Rating of Healthcare Aide by users according to

age group

Usability Issues: Technical and Non Technical

0.00 1.00 2.00 3.00 4.00 5.00

Overall Usefulness Easy to

use Easy to input navigation interface

Technical Non Technical

Figure 6: Rating of Healthcare Aide by knowledge of users

Usability Issues: Overall

0.0 1.0 2.0 3.0 4.0 5.0

Overall Usefulness Easy to use Easy to input Interface

navigation

Figure 7: Rating of Healthcare Aide by users as a whole

Input Definition:

Who will be the users of the system? We selected

several resident doctors and medical professionals to get the firsthand feedback about this application

What tasks will be analyzed? All the major tasks like

maintaining a patient database, updating or deleting any patient information if needed, file transfer among doctors, chatting among doctors or patients, etc have been

analyzed

What is the correct action sequence for each task?

First of all, we have briefly explained to each user about the sequence of tasks and what they should finally get Also, we recommended they use the “HELP” section when necessary

We have followed the cognitive walkthrough strategy

on our first prototype of Healthcare Aide We collected the feedback from the users (doctors, patients, and medical professions) by giving a questionnaire (it is attached in the Appendix section) The distribution of the participants is given below in Table 3:

Table 3 Distribution of participants

Survey Statistics (Participants)

Men 10

Modifications were made based on their responses,

and we have implemented a second prototype Healthcare

Aide has also been rated from the users’ perspective

Figure 4-6 shows gender wise, age group wise and

technical knowledge wise respectively Figure 7 shows the

users’ overall rating It also shows usefulness, simplicity of

use, and ease with which to input data as well as navigate

from one screen to another

Battery Power Consumption

40

60

80

100

Time Interval (min)

PDA1(idle) PDA1(run) PDA2(idle) PDA2(run)

PDA3(idle) PDA3(run)

Figure 8: Power consumption by all PDAs before and after

running the Healthcare Aide

8.3 Performance measurement

Power consumption is one of the most important

performance metrics of pervasive computing applications

and services, and Healthcare Aide seems to be very

power-conservative It consumes the minimal amount of battery

power possible Figure 8 establishes this as a true

statement Here we have shown two cases for each PDA:

the idle case (when the PDA is ON but not doing anything)

and the active case (when the application is running on the

PDA) Figure 9 shows a similar performance measurement

but based on signal strength, another crucial performance

metric

0 2 4 6 8 10

12 14 16 18 20 -120

-100 -80 -60 -40 -20 0

Time Interval (min) Signal Strength

Figure 9: Signal strength by all PDAs before and after running the Healthcare Aide

9 Conclusions and Future Works

In this paper we have presented the details of our application ‘Healthcare Aide’ It has been designed to facilitate doctor-doctor, resident doctor-doctor, patient-doctor and nurse-patient-doctor communication for real-time decision making and provide a convenient environment for better healthcare In our first prototype of ‘Healthcare Aide,’ we have tried to address some frequently occurring situations between patients and physicians that are of immense importance This tool has been designed to create

a healthier environment in the hospital through the creation

of a secure passage for two-way interactions and flow of information At the same time, this tool has proved the effectiveness and utility of our developed middleware MARKS

As a result of analyzing the feedback from users, we are planning to add the following features:

o Sometimes doctors want to add a note containing his/her comments when sending a patient record We will provide this feature in our upcoming version

o The chatting and information sharing service can be performed using voice command

o Currently the mode of authentication is password-based We are extending this authentication feature by using a fingerprint and/or signature which will ensure

a more robust security service

Our vision is to provide a heterogeneous way of communication to make a bridge between the existing fixed infrastructure and wireless approach We believe that

it will become an essential aid, not only for the medical

community but for society as a whole

Appendix

Questionnaire for Evaluation

1         Overall, how would you rate the services? (1=very bad,

5=excellent)

2         Overall, how would you rate this application? (1=very bad,

5=excellent)

3         Effectiveness of the application (1= not effective at all,

5=very useful)

4         How easy the application to use? (1=very hard, 5=very

easy)

5         How easy to give the input? (1=very hard, 5=very easy)

6         How easy to navigate the interface? (1=very hard, 5=very

easy)

7         How easy to establish the initial wireless connection?

(1=very hard, 5=very easy)

8         How easy to get the desired output after performing an

action? (1=very hard, 5=very easy)

9         How effective the interface is for the small screen? (1=not

at all, 5=very effective)

10      How effective the help section? (1=not at all, 5=very

effective)

11      According to you, which feature is unnecessary?

12      According to you, which feature is most useful?

13      According to you, who will be the most beneficial of this

application?

14      Will you choose this application if it is free? If not, why

not?

15      Would you recommend this application to your friend? If

not, why not?

16      Can you recommend any more features that should be

incorporated in this software?

17      Any final suggestions or comments for improvements.

Acknowledgement

The authors appreciate the assistance of Dr.Kaiseruzzaman

Khan, Paula Stroud, and Karl Stamm for their helpful

suggestions to improve this paper

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