Expert answer:Mobile Computing in Healthcare

Expert answer:Summarize the five papers into one paper that include the section mentioned below:1-intro2-problem statement3-proposed solution4-techniques5-findings6-conclusionNote: the paper must be not less than 8 pages
surveypaper_darshan_seif.pdf

iwsawc.pdf

technology_of_health_care_services.pdf

pdf_wirelessandmobilecomputing.pdf

gi_proceedings.15_22.pdf

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Mobile Computing in Healthcare
Needs, Applications, Issues and Future Trends
Darshan Modani
University of Houston
Department of Computer Science
Houston TX USA
domodani@mail.uh.edu
Abstract—Some of the key elements in revolution
includes advancement in digital networks that
expand the power of cellphones. These advancements
in mobile computing has a potential impact to
improve health care delivery, reduce health care
costs, make health care services more convenient to
patients and increase the overall efficiency and
effectiveness of health care providers. Wireless
technologies enable health care providers to monitor
patients remotely, and give them timely health
information, reminders and support. In this paper,
we identify some key applications of wireless
computing in healthcare environment, challenges and
issues in bringing mobile computing to everyday
practice and future trends.
Seif Eldrasi
University of Houston
Department of Computer Science
Houston TX USA
smhamed@mail.uh.edu
subscribers in US. This number has grown to nearly 303
million by 2011 and nearly 96% of US people have cell
phones. Global cellphone penetration is continuing to
grow rapidly. As the popularity of cell phones increased,
so has their functionality.
Keywords-component;
healthcare;
mobile;
cellphone; ubiquitous; applications; health IT;
I.
INTRODUCTION
With the recent outburst of smartphone technologies
and worldwide deployment of mobile and wireless
networks, it has become quite obvious that wireless
infrastructure can support many current and emerging
healthcare applications. For an example, consider a
clinician who has just provided an inpatient service to a
patient. The clinician could enter a description of the
service on a paper record at the patient’s bedside.
Alternatively, the clinician can simply enter specific
parameters of the service in a mobile device. This data
entered are automatically sent to the billing systems via
wireless networks. How cool would be that? Another
interesting application would be writing a prescription
using a mobile device that transmits the order via the
Internet to the appropriate pharmacist.
Cell phones were first introduced in US in mid1980s. In 1984, there were just 340,00 cell phone
Figure 1. Mobile Computing facts from MorganStanely.
In the first year of its existence, 1981, the IBM PC
sold 100,000 units. Most of those buyers were geeks or
leading-edge business users. Apple’s iPad sold 1 million
units in less than one month and 2 million units in just
two months. IPad users still include geeks and business
types but they are just as likely to include your six-yearold and your grandmother.
The introduction of telecommunications technologies
in healthcare environment has led to an increased
accessibility to healthcare providers, more efficient
processing, and a higher quality of healthcare services.
While the current and emerging wireless technologies
could improve the overall quality of service for patients
in both cities and rural areas, it also reduces the stress
and strain on healthcare providers while enhancing their
productivity, retention and quality of life and reduces the
long-term cost of healthcare services. Due to lack of
accurate and comprehensive information at the location
and time when it is needed, lots of medical errors occur
which ultimately result in wrong diagnosis. The required
information can be made available at any time any place
using urbane devices and wireless networks. Although
these errors cannot be completely eliminated, but some
of the informational errors can certainly be removed by
such technologies. Some of these technologies include
location tracking, user interfaces, body sensors, and
short-range wireless communications of health
monitoring, universal wireless access to increase the
accessibility of healthcare providers, and trustworthy
communication between devices, patients, and
healthcare providers.
In this paper, we present the trends and applications of
mobile computing in healthcare industry. We also
present a vision of pervasive healthcare that includes
requirements and applications of pervasive healthcare.
II.
SUITABILITY OF UBIQUITOUS DEVICES FOR
HEALTHCARE
Particularly cell phones have four attributes that make
them well suited for delivering high quality health care
applications. These attributes include:
A. Personal
As each cell phone is personal to a particular person,
applications can be targeted to that particular individual.
B. Ubiquitous
Individuals take their cellphones wherever they go.
Therefore, continuous physiological monitoring is
possible everywhere and information and services can be
delivered when and where they want.
Because of their ubiquity with low cost, cell phones
and other mobile computing devices are very well suited
for supporting and treating many diseases. These
technologies make it possible for healthcare providers to
monitor patient’s health and to guide patient’s self-care
beyond the limits of clinic, improving overall outcome
and reducing cost. Mobile healthcare are primarily
driven by five forces:
• Providing
medical
and
health
related
information to consumers via text messages or
interactive applications is driven through large
content becoming available through Internet.
Because of cell-phone’s ubiquity and personal,
they have ability to deliver content anytime
anywhere.
• As the awareness about health concerns and risk
grows among individuals, they are more open to
technologies that can quickly signal them or
provide alerts about potential hazards.
• As the size of sensors are reducing continuously,
and becoming more reliable and less power
hungry, they are likely to be incorporated into
portable and ubiquitous devices like cellphones.
• Wireless networks are becoming more stable day
by day. This extends the opportunities to connect
patients with physicians or healthcare providers.
Remote monitoring of patients has become
possible and can aid providers in rapidly
identifying signs of abnormal functions and
provide timely medication or treatment.
The Bulletin Healthcare survey also found notable
differences in mobile device adoption rates among
different specialties:
TABLE I. MOBILE DEVICE ADOPTION RATES AMONG DIFFERENT HEALTH
SPECIALIZATIONS (HIRSCH, 2011)
Specialty
Mobile Adoption
Physician Assistants
41%
Emergency Room Physicians
40%
C. Connected
Cardiologists
33%
Cell phones provide direct access to valuable
resources and information. They also provide support to
peer groups.
Urologists
31%
Nephrologists
31%
Dermatologists
30%
D. Increasingly intelligent
Gastroenterologists
30%
Smartphones are essentially as intelligent as small
computers that can capture, store and process
information.
Psychiatrists
28%
Optometrists
28%
Radiologists
24%
Rheumatologists
22%
Endocrinologists
21%
Oncologists
20%
diagnoses. A device called Vitaphone which has sensors
integrated into normal cellphone can collect
electrocardiogram readings anytime and with its GPS
capability, medical assistance to the patient can be
provided if needed.
Clinical Pathologists
16%
B. Blood Glucose Monitoring
Specialty
III.
Mobile Adoption
APPLICATIONS OF MOBILE COMPUTING IN
HEALTHCARE
There are two major categories of mobile applications
for healthcare:
A. Applications that monitor physiological functions
and send information to patients
Monitoring applications such as examining blood
glucose level, heart functions, vital signs rely on sensors
that may be portable, or implantable. Communications of
these types of applications are primarily from patient to
providers. They offer more accurate diagnostics and rapid
response to medical emergencies.
B. Applications that deliver information and feedback
to patients
Patient appointment reminders and health education
are examples of this kind of application.
Communications in these applications are majorly from
providers to patients.
IV.
PHYSIOLOGICAL MONITORING APPLICATIONS
These applications enable remote continuous
monitoring of various physiological functions as they go
about their daily activities. This results in more up to
date and accurate diagnoses, which ultimately improve
patient’s health problems. They make continuous
monitoring of patients possible as they go about their
daily life activities. Some of these applications include:
A. Cardiac monitoring
It was introduced in 1947. This device enabled
continuous recording of heart function outside clinical
setting. The patients typically wear the monitor, which
includes set of electrodes attached to patient’s chest and
a recording device. The patient normally wears this
device for a period of 24 hours and then returns it to their
physician for analysis of readings. Newer devices have
the capability of wirelessly communicating the readings.
Researches have shown that extended cardiac monitoring
can detect a larger range of problems than short-term
Heart diseases, stroke, blindness, kidney failure,
pregnancy complications, and limb amputations are all
consequences of diabetes if not properly controlled. To
avoid such complications, a diabetic patient must
carefully monitor blood sugar level. Wireless and
ubiquitous devices can be a useful tool to diabetics and
physicians to help manage the disease better. With the
use of GlucoPhone, users can send their monitoring data
to online medical management database and also, at
user’s discretion, can be forwarded to personal
physician. This can help physicians recommend a change
in medication by tracking patient’s health status.
V.
PATIENT COMMUNICATION AND SUPPORT
APPLICATIONS
Along with supporting remote monitoring, cell phones
and wireless devices provide a wide horizon for
communication between patient and healthcare
providers. Such applications not only allow providers to
communicate with the patients anytime anywhere, but
they also deliver-health related information at a time and
place where they have utmost influence. The outcome is
lower-health related costs. Some of these kinds of
applications include:
A. Patient Records – EHRs and PHRs
Many systems like eClinicWorks, LifeRecord,
MacPracticeMD offer smartphone capabilities. With the
implementation
of
American
Recovery
and
Reinvestment Act of 2009, stimulus funding will be
distributed to health providers who implement Electronic
Health Records (EHRs). Mobile EHRs could allow
physician to access the patient’s information that further
allow physicians to communicate to the patients
anywhere at anytime. Also, as consumers get more
engaged to in tracking their health records, Public Health
Records (PHRs) will gain acceptance. There are couples
of PHR’s that are available for smart phones. For
example, Polka works for iPhone. It stores and analyses
the consumer’s personal health data, and offers health
reminders. In addition to this app, there are several other
emergency apps available.
B. Health Education
Health educators generally face difficulty in reaching
out young people to educate regarding health.
Cellphones can be used as a promising tool to reach out
young people. Several health campaigns that deliver
messages to cell phone can be an assuring alternative.
For an example, in 2006, the San Francisco Department
of Public Health introduced SexInfo. SexInfo is a free
service that answers youth questions about sex through
text messaging. It also gives contact numbers and
location of local clinics.
C. Appointment Reminders
Giving out frequent reminders about patient’s
appointments through text messages or through an
interactive application can improve administrative
efficiency and increase the effectiveness of physician’s
time. This could ultimately result in healthcare savings.
D. Public Health Alerts
Text messaging can help in tracking disease outbreaks
and also in providing timely alerts regarding health
hazards or epidemics. Other potential applications could
be to provide warnings of dangerous levels of pollution
or notifying upcoming tsunami.
E. Doctor-Patient Communication
Communication between doctor and patient is very
important to as in to convey important information to
patient or to update patient’s health status to doctor so
that doctor can act instantly. Live, two-way video
conferencing app between doctor and patient would be a
direct way of communication between doctor and
patient. While these technologies can help physicians
provide more timely diagnoses and treatment, it makes
health care more convenient and pleasing for patients.
VI.
PROBLEMS AND ISSUES
There are many challenges and issues in realizing the
usage of mobile computing in healthcare. A broader
view of such challenges includes lack of willingness to
use alternative methods to get care, lack of
comprehensive coverage of wireless and mobile
networks, reliability of wireless infrastructure,
limitations of handheld devices, lack of medical sensors
in mobile devices and privacy and security. According to
PriceWaterhouseCoopers Survey, one half of US health
consumers are willing to take online care and
consultation with clinicians over a phone. Figure 2 cites
the overall results.
Figure 2. Consumers willingness to Use Alternative Methods
to get Care, 2009
A. Health System Not Configured to Use Wireless
Applications
To benefit from the wireless applications and mobile
applications, the health care system has to adjust to the
new technological advancements. The current system is
not well configured to meet the health care needs.
Wireless tools can help to overcome this shortcoming,
but their usage will be limited because the tools are not
linked to each other. There are several efforts being
made towards this direction.
For example, Alere Medical, one disease Management
Company, remotely monitored patients using a device
called DayLink monitor. This act ultimately got success.
Results showed that diabetic patients who received
support through the monitor reduced medical costs up to
40%.
B. Privacy and security
One of the primary concerns of mobile health
computing is protecting the privacy and security of
patient information. There are many issues of which
providers or patients are unsure about. Some of these
are: How can patient and providers be sure that only
authorized persons will receive the date? What happens
if wireless device that contains important data is
misplaced or stolen? Has the information transmitted
securely or not?
According to Health Insurance Portability and
Accountability Act of 1996, wireless technologies must
meet privacy and security provisions. Some of the
policies that govern wireless health care applications at
Yale University are:
• If protected health care data is stored on the
handheld mobile device, it should be encrypted
and also the access should be passwordprotected.
• There should be a user id/password level
security to protect the data if the device is stolen
or lost. There should be user/device validation
during synchronization and encryption of data
stored on the device.
• Before and data transmission, authentication
should be enforced and the data should be
encrypted during transmission.
C. Lack of Standards
Most of the applications and technologies available in
mobile healthcare industry are stand-alone tools. These
all applications lack technological standard. This means
some applications may not be compatible with other or
some applications will work only on specific type of
cellphone. One of the most important issues is ensuring
that the data generated for monitoring devices are
encoded in standard format, which may allow the
information to be stored and managed by different types
of data stores.
D. Lack of Total Network Coverage
No cell phone networks offer complete network
coverage across the entire United States. Many rural
areas of the countries still lack network coverage, and
even in major cities, the service is sometimes poor.
These limitations may be problematic for wireless health
care applications. Joseph Kvedar, M.D. director of the
center for Connected Health in Boston mentioned: ”If
one the text message out of hundred messages between
friends goes amiss, it doesn’t matter. But if one heart
reading of a cardiac patient is not delivered, someone
could die.” At the minimum, the applications should be
designed such that devices should be able to store the
data or messages whenever they are offline and to
deliver the data or messages when they become online.
VII. HEALTHCARE SMARTPHONE APPS
There are many smartphone applications being written
for smartphones that are focused on professional health
management or targeted at healthcare professionals. As
of February 2010, there were 5805 health, medical and
fitness applications within the Apple AppStore. The
figure 3 depicts different categories of medical apps and
their share.
Figure 3. Medical Iphone Apps, 2010
Some of the apps are featured here:
A. BMI
Developer: DVMagic Studios Inc.
This app simplifies many calculations necessary in
determining various factors of your body health stats.
This application helps to sort out the many factors (BMI,
BMR, LBM, Body Fat%, Water Consumption, Body
Shape, Body Measurements, weight, height, gender,
activity level, etc.) into a quick and easy to understand
summarized manner. This tool can be used in weight
loss, gain, or maintenance for a healthier overall
lifestyle.
B. Epocrates
Developer: Epocrates
The company claims that more than 900,000 health
care professionals regularly use Epocrates to make
medical decisions and improve patient safety. This app
provides access to things like clinical information on
prescription medicines, effective treatments among overthe-counter products and drug interactions, information
on things like alternative medicines, treatment guidelines
and medical definitions.
C. Medical Calculator
Developer: MarketWall.com
This application helps doctors and nurses compute
useful formulas and equations. With more than 200,000
installs worldwide, this is the most popular Medical
Calculator for the iPhone. This clinical calculator gives
you quick access to calculations that are too hard to
memorize or perform in your head.
D. Calorie Track
Developer: SkyWolf Tech
This app helps you track your personal food intake. It
allows easy entry of meal information on your iPhone or
iPod where ever you go. It also keeps track of what you
are eating and the nutritional values as you are eating. It
graphs your food history to see trends.
E. BP Tracker – Blood Pressure Tracker
Developer: BHI Technologies, Inc.
You can use this to easily log your BP, HR,
medication and other useful information on your iPhone.
It
provides
powerful
graphing
that
shows
weekly/monthly/quarterly trends and logging your
medication data. This app shows tips to help you
maintain
a
normal
blood
pressure
level
and supports to write notes for each BP entry.
F. BKS Medical Encyclopedia
Developer: BEIKS LLC
The application enables anyone with an Android
handheld to carry vast amounts of information in their
pocket or purse. The encyclopedia includes medical
terms, pertinent scientific items, abbreviations,
acronyms, jargon, institutions, projects, symptoms,
syndromes, eponyms, and medical history.
G. Menstrual Calendar
Developer: WITIZ
This app allows every woman to track period,
ovulation, temperature & more. You can have cycle
Report and Basal Body Temperature Chart. Also use
historical data to forecast menstruation and ovulation.
VIII. FUTURE TRENDS
There are several new healthcare applications that can
evolve along with current applications such as mobile
telemedicine. Some of these applications are:
A. Intelligent Emergency Management System
Intelligent Emergency Management System could be
devised using the intelligence and information from
mobile and wireless networks. This system would be
able to manage a call received due to accident and
effectively manage the emergency vehicles.
B. Health-aware mobile devices
Mo …
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