Ubiquitous Health: An Emerging Technology in Todays World
Submitted by Serena Skinner, RN, BSN, FNP-student
Tags: aging health care systems technology
In a world with advancing technology, it is to be expected that healthcare will be leading the way. There is an ever number of advancing technologies that are being developed and put into clinical practice, one being ubiquitous health. Ubiquitous health is defined as “an emerging area of technology that uses a large number of environmental and patient sensors and actuators to monitor and improve patients' physical and mental condition” (Brown & Adams, 2007, p. 52). Currently the use of ECG holter monitoring is the most well recognized form of ubiquitous health. But the implications in advancing this technology may result in implantable devices that have the ability to detect even the slightest change in the human body. This technology has the potential to revolutionize the healthcare industries, patient monitoring and the way care is provided.
Ubiquitous health can be implemented by the use of Body Area Networks, or BANs. Many of these are done wirelessly and thus are called WBANs. These WBANs consist of network nodes that collect data such as vital signs, physical activity, environmental factors such as location, temperature, light levels, etc., and evens the possibility of blood sampling. These nodes can be implanted in the body or may be as simple as electrodes or patches placed on the body (Jovanov & Milenkovic, 2011). The use of WBANs provide the ability to continuously collect data for analyzing, and monitoring. The collected data is recorded onto a server and can be placed in a cloud to allow providers access to the information at any time.
There are many reasons that can be found to use a WBAN. According to Brown and Adams (2007), “The main purpose of these sensors and actuators is to help patients and their carers or providers monitor health status and design and implement interventions to improve that status” (Brown & Adams, 2007, p. 55). Essentially, the WBANs are providing all the needed information to design a care plan for individuals. Additionally other uses for WBAN’s include using the technology in assisted living, preventative medicine or even with fitness management by allowing the data collection of physical activity, body mass index, vital signs, even levels of exertion (Jovanov & Milenkovic, 2011). Over all there are several beneficial avenues to consider with BANs.
With the use of WBANs, there must be considerations for a number of aspects. The first is the ethical implications that may come form using WBANs. Some of the main ethical considerations may include privacy of the information that is collected, who owns the information, and who has access to it along with how it is stored. There is also a concern that the use of WBANs will be potentially used for behavior modification. Additionally there is concern about who will have access to use WBANs due to cost? If there is an error in the technology, who is responsible for the outcome, especially if harm comes to the patient (Brown & Adams, 2007)? Each of these issues is leading the discussion for the ethical considerations surrounding WBANs.
System challenges may dictate how WBANs may be implemented and used. There is going to be a disparity across different programs that use this technology. Low power operation allow for smaller units to be won but may lack the ability to perform on all platforms, especially those that patients would interface with such as a mobile phone. System integration may reduce costs and size of a ubiquitous health monitor thus increasing the wearability and availability to patients. This also allows for use of the internet systems authentication leading to more secure communication of the data that is collected. Furthermore, understanding how user localization and identification is used may provide a sense of security and meaningful use to the consumer but may be subjected to a privacy breech (Jovanov & Milenkovic, 2011).
Patients’ willingness to use and ability to understand what is being done needs to be considered. The ease of use, how comfortable it is to wear, cost and understanding to the user all account for how well WBANs will be accepted in the general population. Additionally if there are security and privacy issues, the healthcare industry will face many challenges in implementation of WBANs (Jovanov & Milenkovic, 2011).
The role of the APRN will without a doubt be affected by the implementation of ubiquitous health. The ability to access ubiquitous health information assists in the reduction of errors based on lack of information or improper information. By having a system that delivers all the pertinent clinical information and can provide a larger picture other than what is seen just during a visit, the APRN can make better informed decisions that can result in better patient outcomes. It is up to the APRN thoroughly analyze the data that is collected to ensure that proper decisions are made (Feied et al., 2008).
Literature Review
In the article IAServ: An Intelligent Home Care Web Services Platform in a Cloud for Aging-in-Place the authors discuss the concept of aging in place (Su & Chiang, 2013). This refers to the ability to provide more accurate healthcare to elderly population outside of the hospital setting through the use of cloud computing, intelligent agents and web services. The hope is to provide more personalized healthcare at a lower cost all while improving the quality of life of the elderly. To accomplish this, Su and Chiang (2013) use the idea of Ambient Intelligence (AmI). “AmI refers to a vision of the future in which people are empowered by an electronic environment that is aware of their presence, and is sensitive and responsive to their needs. It aims at improving quality of life by creating the desired atmosphere and functionality via intelligent, personalized interconnected systems and service. AmI implies a seamless environment of computing, advanced networking technology and specific interfaces. It is aware of the special characteristics of human presence and personality, addresses human needs and is capable of responding intelligently to spoken or gestured commands, and can even engage in intelligent dialogue with the user” (Su & Chiang, 2013, p. 6108).
In the application of Ami to care services, Su and Chiang (2013) propose the use of an Ambient Intelligent Community Care Platform (AICCP) that would implement the use of radio-frequency identification (RFID) and mobile agent technologies to aide in the management of patients. The RIFD would be used to easily locate patients such as those with Alzheimer’s or dementia while mobile agents can be used to record data from the patients and be reviewed in a timely fashion due to automatic downloads. AmI may also be used to contain demographics and other personal data (Su & Chiang, 2013).
Currently even though the advancement of this technology is fast approaching there is concerns over security and privacy issues. Due to the mobility and large scale use of AmI the susceptibility of personal information being leaked or managed by the wrong individuals (Su & Chiang, 2013). Solutions are being worked on so that this technology can be put to use in real life.
In the article Cloud Based Emergency Health Care Information Service in India the authors discuss the use of cloud computing to assist medical providers, specifically those providing emergency care, in attaining the needed information about patients (Karthikeyan & Sukanesh, 2012). The main component of accessing the available records is achieved through palm vain recognition. If a person has been scanned previously and registered, the palm may be placed against an infrared sensor to detect and recognize the vein pattern allowing for identification and access to medical records and demographics. Everything down to smoking and alcohol habits, sleep patterns, primary doctors and family history may be accessible (Karthikeyan & Sukanesh, 2012). Naturally all of this data would need to be loaded into the system prior to being accessed. Advantages of having a ubiquitous health access includes increased work efficacy, complete records if the patient is unable to provide information, and reduced costs (Karthikeyan & Sukanesh, 2012).
The potential evolution for the use of Ambient Intelligence may include allowing the elderly population to stay at home longer, improving their quality of life with maintaining dignity and reducing the cost of aging healthcare. Chronic conditions may be more clearly understood with continuous data collection, thus leading better research and management of disease. Additionally the data that is collected using the AmI will allow better accuracy of information for providers leading to better outcomes.
The potential evolution for palm vein recognition and cloud computing may assist emergency medical providers in providing optimal care by allowing the access to the individuals past medical history and demographics. This is a crucial point for the unconscious or the mentally incapacitated patient such that arrive in the emergency room for care. These may include the trauma patient, those with dementia or Alzheimer’s, psych patients, children etc. Family that is present during a crisis in the Emergency room may not be able to cope and provide the information that is needed. This technology in an emergency setting could greatly reduce time spent of retrieving medical records and allowing for better decision making.
The implementation of ubiquitous health systems such as those discussed here have a wide range of implications and can be argued from several sides. The ability of this technology to thrust the realm of nursing and healthcare into an advanced information age never seen before. Healthcare providers will have all the precise information needed to competently manage even the most complicated disease processes. The data collected could lead to new management approaches and improved understanding of how disease processes affect the body. There is an ever reaching implication in how this affects the aging elderly, those with chronic illness or even for patients with illnesses that are less understood such as fibro myalgia. Advances may be made in medicine at rates never seen before. Interactions with patients and how their medical information is accessed and collected with have a much less interpersonal approach and more of a data/electronic oriented one. If the data is at our finger tips, less time may be spent talking with patients.
The ethical implication are considerable and will need to be attended to with each and every patient interaction and must evolve as the technology does. New security regulation must be achieved within the technology systems to ensure that patient privacy and personal information is preserved. Failure to do so could be catastrophic in the realm of HIPPA and for all electronic security in the medical field.
More research and information needs to be collected before any of the advanced system of ubiquitous health can be placed into reality. Having the security to protect PHI is going to be key prior to implementations. Additionally, studies will need to be done to scrutinize the reliability of the data produced by a ubiquitous health system, along with the patient and provider acceptance of it and the meaningful used derived from such systems. Once it has been established that these needs have been met, the use of ubiquitous health systems will propel the field of medicine and nursing into a new era, producing some of the most advanced and innovative approaches in healthcare.
References
- Brown, I., & Adams, A. (2007, December). The Ethical Challenges of Ubiquitous Healthcare. International Review of Information Ethics, 8, 52-60. Retrieved from http://www.i-r-i-e.net/inhalt/008/008_9.pdf
- Clinical Outcomes. Academic Emergency Medicine, 11, 1162-1169. Retrieved from http://onlinelibrary.wiley.com/doi/10.1197/j.aem.2004.08.010/pdf
- Jovanov, E., & Milenkovic, A. (2011). Body Area Networks for Ubiquitous Healthcare Applications: Opportunities and Challenges. Journal of Medical Systems, 35, 1245-1254. http://dx.doi.org/10.1007/s10916-011-9661-x.
- Karthikeyan, N., & Sukanesh, R. (2012). Cloud Based Emergency Health Care Information
- Service in India. Journal of Medical Systems, 36, 4031-4036. http://dx.doi.org/10.1007/s10916-012-9875-6
- McGonigle, D., & Mastrian, K. (2012). Nursing Informatics and the Foundation of Knowledge (2nd ed.). Burlington, MA: Jones & Bartlett Learning.
- Su, C., & Chiang, C. (2013, November 12). IAServ: An Intelligent Home Care Web Services Platform in a Cloud for Aging-in-Place. International Journal of Environmental Research and Public Health, 10(11), 6106-6130. http://dx.doi.org/ 10.3390/ijerph10116106