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

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 mhaque}@mscs.mu.edu Ahmed J Khan Assistant Professor of Medicine Medical College of Wisconsin, Milwaukee, Wisconsin, USA akhan@mail.mcw.edu demand curve has increased for PDAs, mobiles, smart phones, and other small hand-held devices, to reach With the advancement of hand held devices, exponential growth With that, pervasive computing is wireless and sensor network pervasive computing has showing its potential in almost every aspect of our life achieved a perfect momentum Formerly, a requirement including hospital, emergency and critical situations, existed that was a serious impediment and threat to the industry, education, and hostile battle fields, to name a few mobility of users the necessary presence of a fixed wired The use of this technology in the field of health has been network This has been resolved by the recent advances in termed pervasive health care The goal of pervasive health wireless and mobile technologies, particularly Bluetooth care is to provide healthcare services to everyone at any and WiFi The advancement of available, portable, low time overcoming the constraints of place, time and cost mobile devices (PDAs, cell phones, etc.) has resulted availability of doctors, nurses and resident doctors in the user’s mobility at unprecedented levels As these Healthcare professionals need information delivery devices can communicate with one another, the combined tools for accessing information at the point of patient care capabilities can be leveraged to form a useful new set of as well as transporting the information to other relevant tools Presently, pervasive computing is being extended sites Personal digital assistants (PDAs), or hand-held into the sophisticated healthcare sector with the promise of devices demonstrate great promise as point of care providing an easier and more efficient mode of information devices A 1995 study on the use of PDAs at communication between physicians and patients or the point of care found that hardware constraints, such as between the physicians themselves In this paper we memory capability limited their usefulness [28] Since this provide the details of our application ‘Healthcare Aide’, study was completed, over the last 10 years, hand-held which has been designed to provide not only more computer technology has advanced rapidly, and as of 2001 convenience for doctor-doctor, resident doctor-doctor, and 2002, between 26 and 50% of physicians used PDAs patient-doctor and nurse-doctor interaction but also a [29] ACP-ASIM survey finds nearly half of U.S smooth pathway for real-time decision making Our members use hand-held computers [30] This use appears pervasive middleware MARKS (Middleware Adaptability higher among residents, with one recent study finding that for Resource Discovery, Knowledge Usability and Selfover two-thirds of family practice residencies use handhealing) provides the underlying support for this held computers in their training programs [31] Results of application in a completely transparent manner In this another survey and follow-up interviews on 88 residents in paper, we have also presented our survey results from seven programs showed most residents use PDAs daily, users’ point view along with performance analysis regardless of practice or whether their program encourages PDAs Uses include commercial medical references and Keywords: Virtual Assistant, Healthcare Aide, Pervasive healthcare, and MARKS personal organization software, such as calendars and address books The results of this study suggests Introduction improvement needed in (a) providing secure clinical data for the current patients of a given resident, and (b) allaying Pervasive computing [18] is the concept that concerns of catastrophic data loss from their PDAs (e.g by incorporates computing in our working and living educating residents about procedures to recover environment in such a way that the interaction between information from PDA backup files) [32] However, humans and computers becomes extremely natural, and the Handheld personal digital assistants (PDAs) have user can get many types of data in a totally transparent undergone continuous and substantial improvements in manner Considering virtual reality, which builds an hardware and graphics capabilities, making them a artificial world in the computer, at one end of the compelling platform for novel developments in high space spectrum, we can put pervasive computing, which embeds occupying usage including even teleradiology The latest computing in the real world at the other Along with the PDAs have processor speeds of up to 400 MHz and forward march of wireless and sensor networks, the storage capacities of up to 80 Gbytes with memory *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) Abstract 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 adhoc 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 where our ‘Healthcare Aide’ provides the perfect solution Section 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 How ‘Healthcare Aide’ adheres to the required characteristics is presented in section Graphical representations showing the placement of MARKS and ‘Healthcare Aide’ and some screen shots of the prototype have been added as supplements Section 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 Motivation Scenario 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 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 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 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 3 Related works Patient A Test Results Figure 1: Patient B Personal Info 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 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, a s 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 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 (ContextAware 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 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 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 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 Development of Healthcare Aide using MARKS How Healthcare Aide adheres all the characteristics: ‘Healthcare Aide’ encapsulates all of the characteristics mentioned in section Some of the characteristics are supported by ‘Healthcare Aide’ itself, whereas the rest are provided by the core services Application Objects MARKS Security Service Resource Discovery Ubicomp Assistant Service Knowledge Usability Healthcare Aide Selfhealing Context Processing Core Service [Providing transparency over ad hoc communication] ‘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 Code size of Healthcare Aide Healthcare Aide Executable file size (KB) 29 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 How to use Healthcare Aide The necessary hardware and software requirements for proper functionality of Healthcare Aide are as follows: Operating System Figure MARKS Architecture [2, 22] Lines of code 2111 Hand-held devices (for example Dell Axim X50v PDA) with Windows CE operating system Wireless card (Bluetooth or IEEE 802.11b) 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  Chat with other doctors Requesting a file Try to access a file patient record 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 Evaluation We can evaluate in the following ways: Implement a prototype Cognitive walkthrough strategy 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 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 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 Characteristics of cognitive walkthrough strategy Applicable stages: design, test, and deployment Personnel needed for the evaluation Usability issues covered Users: Some resident Effectiveness: YES doctors and medical Efficiency: YES professionals Satisfaction: YES Can be conducted remotely: NO Can obtain quantitative data: YES Figure 7: Rating of Healthcare Aide by users as a whole Input Definition: Figure 4: Rating of Healthcare Aide by users (Men and women) 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 Distribution of participants Figure 5: Rating of Healthcare Aide by users according to age group Figure 6: Rating of Healthcare Aide by knowledge of users Survey Statistics (Participants) Total 14 Men 10 Women Technical Non Technical Age < 30 Age 30-50 Age >50 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 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 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 powerconservative It consumes the minimal amount of battery power possible Figure 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 shows a similar performance measurement but based on signal strength, another crucial performance metric In this paper we have presented the details of our application ‘Healthcare Aide’ It has been designed to facilitate doctor-doctor, resident doctor-doctor, patientdoctor and nurse-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 passwordbased 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 Figure 9: Signal strength by all PDAs before and after running the Healthcare Aide Conclusions and Future Works Overall, how would you rate the services? (1=very bad, 5=excellent) Overall, how would you rate this application? (1=very bad, 5=excellent) Effectiveness of the application (1= not effective at all, 5=very useful) How easy the application to use? (1=very hard, 5=very easy) How easy to give the input? (1=very hard, 5=very easy) How easy to navigate the interface? (1=very hard, 5=very easy) How easy to establish the initial wireless connection? (1=very hard, 5=very easy) How easy to get the desired output after performing an action? (1=very hard, 5=very easy) 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 14 15 16 17 According to you, who will be the most beneficial of this application? Will you choose this application if it is free? If not, why not? Would you recommend this application to your friend? If not, why not? Can you recommend any more features that should be incorporated in this software? 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 References [1] BizJournals, “Healthy Investment for hospitals: wireless nets”, September 2004, http://www.bizjournals.com/industries/ health_ care/ hospitals/2004/09/20/eastbay_story7.html [2] MARKS middleware, www.mscs.mu.edu/!ubicomp [3] N Saranummi, I Korhonen , M van Gils and S Kivisaari, “Barriers limiting the diffusion of ICT for proactive and pervasive health care,” in Proc of the IX MEDICON, Pula, Croatia, 2001 [4]http://www.ercim.org/publication/Ercim_News/enw60/caceres html [5] ] http://www.pervasivehealthcare.dk/projects/index.html [6] Rodriguez, M., Favela, J., Gonzalez, V., and Muñoz, M.A (2003), “Agent-based Mobile Collaboration and Information Access in a Helathcare Environment”, In eHealth: Application of Computing Science in Medicine and Healthcare I Rudomin, J Vazquez and J.L Diaz (eds.) Published by the Instituto Politecnico Nacional Mexico, 2003 ISNB 970-36-0118-9 pp 133-148 [7] Muñoz, M., Gonzalez, V., Rodríguez, M and Favela, J, “Supporting Context-Aware Collaboration in a Hospital: An Ethnographic Informed Design” Lecture Notes in Computer Science Volume: Volume 2806 September 2003 pp 330 - 344 [8] Muñoz, M.A.; Rodriguez, M.; Favela, J.; Martinez-Garcia, A.I.; Gonzalez, V , “Context-aware mobile communication in hospitals”, Computer IEEE, 2003 36(9): p 38-46 [9] Favela, J., Rodriguez, M., Preciado A and Gonzalez, V., “Integrating Context-Aware Public Displays Into a Mobile Hospital Information System”, IEEE Transactions on Information Technology in Biomedicine Vol Number September 2004 [10] Tentori, M., Favela, J., Gonzalez, V and Rodríguez, M., “Supporting Quality of Privacy (QoP),” in Pervasive Computing Proceedings of Encuentro Internacional de Ciencias de la Computación (ENC) 2005 IEEE Computer Press, Puebla, Mexico ( [11] Tentori, M., Favela, J and González, V, “Designing for Privacy in Ubiquitous Computing Environments”, Prooceedings of UCAMI ’05 Granada, España (pdf file) [12]http://www.eecs.harvard.edu/~mdw/proj/codeblue/ [13] Victor Shnayder, Bor-rong Chen, Konrad Lorincz, Thaddeus R F Fulford-Jones, and Matt Welsh “Sensor Networks for Medical Care”, Harvard University Technical Report TR-08-05, April 2005, [14] Konrad Lorincz, David Malan, Thaddeus R F FulfordJones, Alan Nawoj, Antony Clavel, Victor Shnayder, Geoff Mainland, Steve Moulton, and Matt Welsh, “Sensor Networks for Emergency Response: Challenges and Opportunities”,, In IEEE Pervasive Computing, Special Issue on Pervasive Computing for First Response, Oct-Dec 2004, www.eecs.harvard.edu/~mdw/papers/codeblue-ieeepvc04.pdf [15] http://www.xbow.com/Products/Wireless_Sensor_Networks.htm [16] http://www.moteiv.com/ [17]Cognitive Walkthrough http://www.pages.drexel.edu/~zwz22/CognWalk.htm Strategy, [18] M Weiser, “Some Computer Science Problems in Ubiquitous Computing”, Communications of the ACM, Vol 36, No 7, July 1993, pp 75-84 [19] Shameem Ahmed, Moushumi Sharmin, and Sheikh I Ahamed, “Knowledge Usability and Its Characteristics for Pervasive Computing”, The 2005 International Conference on Pervasive Systems and Computing(PSC-05) in conjunction with The 2005 International Multi-conference in Computer Science and Engineering, CSREA Press, Las Vegas, NV, USA, June 2005, pp 206-209 [20] Sheikh I Ahamed, Moushumi Sharmin, Shameem Ahmed, Michael J Havice, and Suresh Anamanamuri, “An Assessment Tool for Out of Class Learning using Pervasive Computing Technologies”, Journal of Information, vol 8(5), September 2005 [21] Moushumi Sharmin, Shameem Ahmed, and Sheikh I Ahamed, “SAFE-RD (Secure, Adaptive, Fault Tolerant, and Efficient Resource Discovery) in Pervasive Computing Environments”, The IEEE international Conference on Information Technology (ITCC 2005), Las Vegas, NV, USA, April 2005, p 271-276 [22] M Sharmin, S Ahmed, and S I Ahamed, “MARKS (Middleware Adaptability for Resource Discovery, Knowledge Usability and Self-healing) for Mobile Devices of Pervasive Computing Environments,” To appear in the Proceedings of Third International Conference on Information Technology : New Generations (ITNG 2006), April, 2006, Las Vegas, Nevada, USA images and data on high-resolution flat panel displays.”, Radiographics 2003 Jan-Feb; 23(1), pp 267-72 [23] S Ahmed, M Sharmin, and S I Ahamed, “GETS (Generic, Efficient, Transparent, and Secured) Self-healing Service for Pervasive Computing Applications”, submitted [37] Goldblum OM, “Semin Cutan Med Surg.” 2002 Sep;21(3), pp 190-201 [24] 100+ applications for http://www.valusoft.com/products/100appspda.html [38] D S Buck ,D Rochon, JP Turley, “Taking it to the streets: recording medical outreach data on personal digital assistants”, Comput Inform Nurs 2005 Sep-Oct;23 (5), pp 250-255 PDA, [25] S Ahmed, M Sharmin, and S I Ahamed, “Ubicomp Assistant: An Omnipresent Customizable Service for MARKS (Middleware Adaptability for Resource Discovery, Knowledge Usability and Self-healing)” accepted for SAC 06 [27] M Sharmin, S Ahmed, S I Ahamed, M Haque, and A J Khan, “Healthcare Aide: Towards a Virtual Assistant for Doctors Using Pervasive Middleware, ” To appear in 1st Workshop on Ubiquitous and Pervasive Health Care (UbiCare 2006) in conjunction with Fourth Annual IEEE International Conference on Pervasive Computer and Communications (PerCom 2006), Pisa – Italy, Mar 2006 [28] The Constellation Project: experience and evaluation of personal digital assistants in the clinical environment, Proceedings of the 19th Annual Symposium on Computer Applications in Medical Care, 1995, 678] [29] Physician's use of hand-helds increases from 15% in 1999 to 26% in 2001: Harris interactive poll results, Harris Poll 8-24-2002 (electronic citation) [30] ACP-ASIM press release, American College of Physicians, 9-3-2002 (electronic citation) [31] J Am Med Inform Assoc (1) (2002) 80] [32] J R Barrett, S M Strayer, J.R Schubart, “Assessing medical residents' usage and perceived needs for personal digital assistants,” International Journal of Med Inform 2004 Feb, 73(1), pp 25-34 [33] M J Bullard, D.P Meurer, I Colman, B R Holroyd, B.H Rowe, “Supporting clinical practice at the bedside using wireless technology”, Acad Emerg Med 2004 Nov;11(11), pp 1186-92 [34] S Breslin , W Greskovich , F Turisco, WFireless technology improves nursing workflow and communications,” Comput Inform Nurs 2004 Sep-Oct; 22(5), pp 75-81 [35] B Raman, R Raman, L Raman, C.F Beauliu, Radiographics 2004 Jan-Feb; 24(1), pp 299-310 Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5105, USA [36] O Ratib, J.M McCoy, D.R McGill, Li M, A Brown, “Use of personal digital assistants for retrieval of medical ... Self-healing)” accepted for SAC 06 [27] M Sharmin, S Ahmed, S I Ahamed, M Haque, and A J Khan, ? ?Healthcare Aide: Towards a Virtual Assistant for Doctors Using Pervasive Middleware, ” To appear in 1st... 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... 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