Transcript Strategisk plan

Towards a location based or context aware
system in a hospital setting?
- technical issues
- issues relating to use in the organisaton
Lill Kristiansen, Prof. Dr. Scient
Inst. for Telematikk, NTNU
[email protected]
www.item.ntnu.no/~lillk
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Content
 Background / some of my previous work
 IP-telephony, calendar/location intergration with
telephony,..(1999-2006)
H.323. annex K, SIP, SIMPLE,
 The group-communication system implemented in pats
(H2003) Mainly technical focus
 The study of the patient signal and presence button as in
use today ethnographic study (EiT 2004),
 A qualitative study of nurses’ attitude toward location
 TOS education (IS, CSCW, CMC, ...)
 Rel. work, further work, cooperation, labs,..
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From tech. to tech. in use
 I come from the technology side
 Building new technology and evaluationg the systems
from a technology perspective
 Ex. of work
 H.323 annex K, integrating http into IP-telephony setup,
 Using location and status into call setup and messages
Forthun’s work to be presented in some more detail
 None of these systems have been tested on real users
 Now interested in the whole issue of user, organization
and technology
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Some previous tech. work of mine
/ my students
 IP-telephony at Ericsson AS, Norway
 Including integration of IP-tel. and url’s as described in
H.323, ver. 4 annex K
 A generic mechanism for sending a url during call setup
phase, typically back to A during ringing phase (preconnect)
 ’opening up’ the telephony network for presence and more
 Also involved in architecture and standardization for
mobility, OSA Open Service access for Ericsson
 Later SIP, SIP-Jain, SIP session mobility based on
location/context (with P-O Osland Telenor)
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Without opening up the telephony network
ComPage (Teepo, UiO, 1999)
web
IP-netw
Webbrowser
2) Click-to-call
3)
E.g.
Netmeeting
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1)
IP-based
tel. netw.
Call
setup H.323
Advantage: Simple
Web-server with
e.g. preferences
/ presence
PSTN
-GW
PSTN
netw.
Service
layer
webbased
Call layer
(Telco
properties)
Opening up the telco network
using H.323 Annex K and OSA
B’s presence service
GUI via e.g. Outlook
Home A
Home B
HSS
9B)
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9
S-CSCF
HSS
7
I-CSCF
14
4
6
5
S-CSCF
15
I-CSCF
16
17
Visited B
P-SCSF
GGSN
SGSN
Radio Access Network
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B
3
Visited A
2
P-CSCF
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GGSN
SGSN
Radio Access Network
A
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H.323 annex K (http service control)
Ex. with Call Waiting (H.450) plus interactions
End-user
C
Terminal Browser
Terminal C
Terminal B
Web-server
Setup
Load(url)
Alerting (url)
callWaiting.invoke
GET url
Display
I’m busy now, but you
may:
1. Wait - it’s urgent,
2. Leave a message
Http 200 OK
(data)
GET url (I’ll wait)
Http 200 OK (data)
Notify B, its
urgent
Connect
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May be endpoint centric (at Bs endpoint) or network centric B’s VASP
’Interactive screening’ using SIP (2005)
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From Østhus and Kristiansen (2005) (ServiceFrame and OSA was not used)
Group communication for healthcare
workers designed in ServiceFrame
The following slides are from student Marte Forthun’s
presentation at Telenor 2004
Forthuns work was mainly technical. Example of opening up the
session establishment pluging in a new concept such as ’group’ into
ServiceFrame
FICTITIOUS DEPARTMENT
Medical Department
Stroke Unit
G1
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G2
G3
Heart Unit
G4
G1
G2
G3
Kidney Unit
G4
G1
G2
G3
G4
SCENARIO 1 FROM TRONDHEIM UNIVERSITY HOSPITAL
– HELP WITH PATIENT
Primary group – G1
Lise
Location:
Room 333
Presence:
Busy with patient
GroupSession: 1
Per
Stroke Unit
Primary group - G1
Help Patient
Location:
Room 331
Presence:
Meeting
GroupSession: 0
Ole
Location:
Room 338
Presence:
Busy with patient
GroupSession: 0
Interface on handheld
terminal
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Lise
Location:
Room 333
Presence:
Busy with patient
GroupSession:
1
Kari
Location:
Room 337
Presence:
Free
GroupSession: 0
SCENARIO 2 FROM TRONDHEIM UNIVERSITY HOSPITAL
– EMERGENCY
Per
Location: Room 333
Presence:
Emergency
GroupSession: 1
Primary group - G1
Primary group - G1
Stroke Unit
Stroke Unit
Emergency
EMERGENCY IN ROOM 333
Interface on the terminals
The patient’s doctor
Emergency team
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CONTEXT-AWARE INFORMATION
”Context is any information that can be used to characterize the situation of an
entity. An enitiy is a person, place or object that is considered relevant to the
interaction between the user and an application, including the user and
applications themselves”
(Dey, June 1999)
USE OF CONTEXT-AWARE INFORMATION IN THE
HOSPITAL
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•Location:
Indoor positioning – sensors
•Calendar:
User’s calendar, group calendar etc.
•Sessions:
Call sessions, instant message session, real-time sessions,..
•Role:
Trained nurse, doctor,...
•Presence Types:
”Free”, ”Busy with patient”, ”Meeting”, ”Lunch”,
”Emergency”, ”Offline”
Forthuns work
 Her work was not tested on users because of several factors:
1. Pats did not support J2ME in 2003, i.e. user interface was not
on handheld (but faked on a PC)
1. hard to simulate a real scenario in this case
2. Pats did not support accurate indoor location at that time
 We had Radionor Cordis radio eye, but that is mostly suited for
places like Nidarosdomen, glassgården etc. (high ceilings)
 location from several sources was prepared for though
3. Today we have Radionor office indoor location integratedin
pats i.e. in items corridor and Svanæs has Radionor
1. Svanæs’ usability lab is not linked to pats though...
 Also Forthuns work focus on session establishment, adding
location info, ’group hunt’ etc
 She does not address establishing a voice stream
 She assumes ServiceFrame everywhere, no use of standards
such as e.g. SIP on endpoint or in network
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Knappen ’The button’ study (2004)
Left: button for the nurse (on door frame in the room)
3 levels: ’help’, ’nurse need help, ’hearth arrest’
Middle: No nurse id , just indicationg ’presence’
Right: Signalling a patient calling for help (ringeknapp)
with room id
OR signalling that a nurse is called (kalt opp)
OR several in round robin fashion
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Location based system in a hospital
setting; an exploratory study
 A qualitative study H06 Lill and two PhD studens (ifi, UiO)
 RQ1 Automatic vs. manual sharing of information:
 Does it matter to the nurses if the location and status is shared
automatically or manually? For instance, are they more
comfortable pushing a button when they enter a room to signal
their presence, or is it OK for them to be tracked continuously as
they move around? Are there places or situations where these
issues are looked upon differently?
 RQ2 Awareness of potential use and misuse of information:
 To what degree do the nurses realize the potential for use of
information when they are sharing location and status with
others? Do they think differently about this depending on who
they are sharing with? Does it matter if they share with fellow
nurses, doctors, or management?
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Methods
 Semi-structured interviews with 3 nurses
 suited as methods since we were not trained in
observations, interviews ’easier’
 Recruited via friends/ connection
 2 recruited via friendship and interviewed on their spare
time (also friends of each other)
 1 recruited via connections already established at a major
Univ. hospital. ’gatekeeper’ Interview done during work
hours
 Content analysis
 (Later 2 more interviews in another country, not yet
analysed)
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Underreseached area
 Little previous literature relating to our RQs
 Previous work such as ’mobility work’ by Bardram and Bossen
tries to separate the spatial dimension (from time)
 Did not work for us, our health domain experts were clearly relating to
both space and time at most occasions
 Bentley 1992 are discussing manual procedures in air traffic
control relating to safety, but not manual ’registration’ per se
 ihospital and Mexico studies all seems to assume that location
tracking is a good thing
 Most previous work has focused on doctors (ihospital, Scholl
et al) and on leading nurses (Mexico)
 Little focus on ’the average nurse’
 and even less on patients!
 We found a need to read A. Strauss (soc. of med. work) and
his SOP (standard op. procedures)
 SOP deals with both time and space)
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Findings (1/3)
 Nurses are positive to management seeing how much
they actually work
 As well as to use such a system as partial evidence in
case of a lawsuit after a death incident
 The health experts (nurses) were talking about manual
work such as refilling of clean sheets and linen and
food serving,
 and this led us to the concept invisible work.
 Star and Strauss: disembedding background work
an attempt by a group of nurses at the University of Iowa to
categorize and make visible all the work that nurses do.
 A location system may visualize (parts of) invisible work
without ‘understanding’ the work (i.e. without a need to
have a category for the work)
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Findings (2/3)
 All our findings must be understood in the context of a ’nurse
identity’ (Palen and Dourish (2003) ’ Identity boundary ‘)
 E.g. nurses concern with patients is a part of their professional self-image
 Our three health experts had opposite views on ‘surveillance’ issues
 The 2 friends of same age showed opposite attitudes
 A manual procedure for registering location
 our idea: to give them ‘more control’ and to introduce a system close to the
existing system (Knappen, 2004)
 maybe they are more interested in what the location info is used for than to avoid
registration as such
 error prone (forget to register in hectic work)
 but with an ICT system a re-registration may cancel the forgotten deregistration
(unlike today’s manual system without id)
 ICT offers new possibilities, but hard for the nurses to imagine all our thoughts
 In most cases they wanted to see identity (role was not enough)
 todays system show no identity
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Findings (3/3)
 Nurses are quite aware of how such a system may be fooled
and show wrong (mediation of reality)
 “You may have someone wear the badge for you”
 “You may have helped in at a hearth arrest on your way back from
lunch” (not having had a long lunch break)
 “A location system may register that ‘someone was there’, but it
tells nothing about the quality of the care”
 The latter comment is important:
 Such a system may result in behavior adapted towards what is
measured (location) and may result in ‘fake care’ (presence, not
care)
 Will a location/presence system help or destroy
 enforcing / visualizing existing ‘rhythms’
 or destroy all rhythms via ‘always accessible everywhere on
every device’?
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Further work
 Mutual learning (Kyng, 95)
 Did the nurses understand our ideas presented orally?
 How to present the system ideas and design to them,
including techn. solutions and limitations?
 How to involve them in the design?
 Presenting UML diagrams to health care domain experts?
 Building prototypes
 Using Service Frame? pats infrastructure (OSA-parts),
others?
 User testing
 In ’real life’? (maybe for home care? at hospital???)
 In ’big lab’ (empty place at St.Olavs in a new building?)
 Approbation work, side effects,...
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TOS Telecommunication, Organization
and Society
 siv.ing education in coop with sociology
 I have oriented students lately towards CSCW work
 but with a particular focus on mobility, real time aspects,
session initiation
Including session negotiation /rerouting based on location,
calendar info, netw. cap. and human decisions
 i.e. a telecom focus (as opposed to IT-focus)
 We could do more cooperation with iss (I believe)
 SOS1010 has proved useful (CMC)
 Discussion on new courses relating to work ongoing
 Also HCI courses from idi may be of relevance
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(Org. and soc.) vs. technology
 IS approachs
 tech. system often built by someone else
 may conclude with some general ’implications for design’ though
 CSCW / HCI approach which may focus on studying users,
building prototypes and real user testing
 well suitable for our student’s mainly techn. skills
 may use well known technology
 focus on the user behavior and/or org. impact
 or focus on e.g. gathering of user requirements (PD)
 may use newer technology
 e.g. use of pats lab
 either focus on technology and techn. tools (NEW!)
 or focus on user requirements and interactions between user (domain
expert) and designer (technical experts i.e. using ’mutual learning’
from Kyng (PD)
 User and organization behavior
 Many CSCW studies assume/use skilled ICT office workers or
comp. sci. students as the users: different for nurses!
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(Canonical) Action Research
AR/CAR
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• Often used in organizational studies (with ICT aspects)
• Often critizised for being ’consultancy, not research’
• RCA: Between the ’consultant/researcher’ and ’client ’ (=boss?)
• Diagnoses may be via ethnographic studies, contextual design,..)
• The intervention may be:
• new ICT system or new orginization/process
• (little focus on building the ICT, rather on deploying /’impl.’)
Life or lab for the testing? (1/2)
 AR assumes a real organization ’real life’ and doing the changes ’for
real’
 Also without AR one may think of studying a prototype ’in real life’


e.g out in the city using TT and/or GSM infrastructure and pats APIs
In real distributed office environments Whitaker has tested some propotypes such as
’hubbub’, and Active Badges, Harper, 1993
 Pats is a lab for building applications (’workshop’/ ’verksted’)
 pats enables the use of the applications in ’live network’ (GSM) via APIs
 suited for testing ’for real’ in the city (mostly outdoor if location is used)
 Some applications can be tested ’for real ’in the city for home care
workers and other filed workers
 Suitable for pats-build applicATIONS using location, SMS, voice telephony
etc via GSM network
 But problems with accurate indoor location services in such a place
as a bed ward
 Other problems with testing in a real hospital as well
 Issues of patient safety if only new prototype is in use
 Issues of ’not real’ if both old system and new prototype needs to be used
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Life or lab? (2/2)
 In ’faked reality’ (’big lab’)
 Dag Svanæs’ usability lab as example
build a fake bed ward (with a short corridor)
Role plays with mock technology
Test real prototypes in this ’faked reality’
 In ’small lab’
 Controlled but ‘artificial’ tests
 ’Negotiator’ by Whitaker tested in such a controlled
environment ’simulating the office desks’ in a test lab)
Negotiator: Negotiate at a desk a new time for the call,
assume it is never suitable to take the call immediately
May be OK for same office environments, but less so for
health workers walking, interrupting, caring, and handling
heart arrests
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References


Scholl, J., Hasvold, P., Henriksen,E. and Ellingsen, G.,"Managing
communication availability and interruptions: A Study of Mobile Communication
in an Oncology Department" Accepted at pervasive07
Ellingsen, G. and Monteiro, E., A patchwork planet. Integration and cooperation
in hospitals, CSCW the journal, 12(1): 71 – 95, 2003.
 http://www.idi.ntnu.no/~ericm/patchwork.pdf


ihospital.dk (head was Bardram, head is now Kyng, Bardram is with ITU now)



Focus on ‘IT’-systems, such as X-ray, EPR. Less focus on ‘person-to.personcommunication’ My student Alex is working on this
many publications
but they are not looking into details of telephony session establishment, here item/pats
can contribute
Bentley, R., et al . 1992. Ethnographically-informed systems design for air traffic
control. In Proc. CSCW '92. ACM Press, pp 123-12
 http://doi.acm.org/10.1145/143457.143470


On manual work / on ethnographic methods relating to ‘implications for design’ i.e.
‘today’ vs ‘tomorrow’
Massimi, M., Ganoe, C., Carroll, J.M. 2007 Scavenger Hunt: An Empirical Method
for Mobile Collaborative Problem-Solving, Pervasive Computing, Vol. 6(1), pp 8187
 http://ieeexplore.ieee.org/xpls/abs_all.jsp?isnumber=4101128&arnumber=4101146&count=17&index=13

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About usability (HCI) testing ‘in lab’ and ‘in real’
Not about general use of system in an organizational setting
References

Woodruff, A. and Aoki, P. M. 2004. Push-to-Talk Social Talk. CSCW the journal 13,
5-6 (Dec. 2004), 409-441.
 http://dx.doi.org/10.1007/s10606-004-5060-x




Teenage users in private setting
Interesting effects of ’instant listen’ with ’delayed answers’
Interesting comments on the ’limitations’ with semi duplex, turned out to be a nice to
have feature
Jones, Q., Grandhi S.A. Terveen L and Whittaker, S.2004, ,People-to-People-toGeographical-Places: The P3 Framework for Location-Based Community
Systems, Computer Supported Cooperative Work (CSCW), Volume 13, Numbers
3-4 pp249-282
 http://www.springerlink.com/content/q465ph125r5681r5/


A conceptual framework, mainly focus on social tasks, dating/lunching etc
Wiberg, M. and Whittaker, S. 2005. Managing availability: Supporting lightweight
negotiations to handle interruptions. ACM Trans. Comput.-Hum. Interact. 12, 4
(Dec. 2005), 356-387.
 http://doi.acm.org/10.1145/1121112.1121114


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A study of how ‘talking sessions’ are established in offices today (univ. researchers in
HCI as users)
A propotype of ‘Negotiator’ for negotiating to call or be called up after x min. or
deferring the call for x minutes
User evaluation of Negotiator in an (artificial) lab setting
References
 PUSH-2-TALK IN VOIP DECENTRALIZED by Florian
Maurer, presented at BB4All, IST project,
 supervised by KTH (using SIP/minisip)
 http://www.bb2all.org/papers/Maurer%20Push-2-Talk.pdf
 Østhus. Osland, Kristiansen (2005) ENME: An ENriched
MEdia application utilizing context for session mobility;
technical and human issues. Proc. UISW (workshop of
EUC2005), LNCSE series 2005;Vol. 3823 pp.316-326
 http://www.springerlink.com/openurl.asp?genre=article&is
sn=0302-9743&volume=3823&spage=316
 Østhus, Egil Conradi; Kristiansen, L.,(2005) A presence
based multimedia call screening service. In: Short
papers companion proceedings to LNCS 3744:
Springer-Verlag . ISBN 2-553-01401-5. pp. 21-25
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Some relevant products / standards
 Bubble talk (Digi, Malaysia, Telenor Pakistan ..)
 BubbleTalk TM is a "click, talk and send" Short Voice Messaging
Service. It's a "talk and listen" messaging alternative to the "type
and read" service provided by SMS. (proprietary solution)
 http://www.digi.com.my/data_services/messaging/datamsg_bt_faq.do
 Push-to-talk over Cellular (PoC)
 semi-duplex (’talk or listen’ / walkie-talkie-like)
 Over WLAN/GPRS/...
 Over TETRA incl. *group communication*
 Ericsson, Motorola, Siemens, Nokia, “Push-to-talk over Cellular (Poc)
specification” (from Aug. 2003, i.e. old version)) input to etsi
 http://www.ericsson.com/multiservicenetworks/distr/PoC_specifications.ZIP
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