Design of Realtime Results in Healthcare
The processes of medical diagnostic and therapy give patients, as well as medical professionals, essential insights of the viability of their health supply system and apply equally as a quality indicator for the whole health support. Due to the existing structures in medical environments, many procedures and processes cause delays and interruptions – thereby influence the perceived quality of the entire health care system.
With the use of realtime technology, through realtime results and their permanent updates, the waiting periods for medical processes could be optimized so that this would affect both, the results and their forms of mediation, as well as the perception of the full process of medical treatments itself.
In this master thesis the ways in which realtime technologies have impact on patients and physicians, as well as on the environment of medical practices and procedures will be examined, to raise the awareness for upcoming opportunities as well as complications by using this technology.
The examination draws especially implications from the theory of the „Laws of Media“ by Marshall and Eric McLuhan, the „theory of technical images“ by Vilém Flusser and the „theory of velocity and technology“ by Paul Virilio. With the method of the scenario technique as well as the research approach of projection, four simultaneous, ficticious scenarios (enhances, obsolesces, reverses into, retrieves) will be described to picture the possible future of medical products, using realtime technology.
The scenarios should project all relevant aspects of realtime systems to the field of medicine to reflect the importance for social, processual and material changes. The projections are not to be understood in a deterministic way, but should demonstrate alternative options to help differentiate the relationship between man and technology further, as well as to map possible applications for the future of realtime technologies in the medical field.
From the consensus of the scenarios three main points can be drawn for designing medical products, using realtime technology. These are used in examples for practical applications in the environment of diagnostic imaging, in order to assess the possible connections and effects of this technology on people, products and the system.
The result of the work should inspire future product developments which plan to integrate realtime technologies in medical products and environments and help them to identify the relevant factors and benefits for their individual project.
The scenarios are intended to project the technological structure and relevant aspects of real-time systems to medicine, to reflect the impact of real-time media in relation to social, processual and material changes.
For each of the four possible developments (enhances, retrieves , obsolesces and reverses into) a fictitious scenario is designed, which gives the characteristics of each key terms of the concepts that are relevant to the scenario building in a medical context. These concepts have been developed on the basis of a thorough literature search (in the fields of medicine, computer science, media and engineering sciences as well as in engineering philosophy), and observations of current product developments and trends primarily from the medical and communication technology development and research, which describes the scenarios. The distinction in social, processual and material factors should serve to examine each not only in their entirety, but also individually.
The future scenarios are supposed to be nondeterministic. They should help to differentiate as a demonstration of alternative options to develop possibilities for the future relationship of humans and technologies to map potential applications for real-time medical technologies of the future.
Which aspects are amplified, enabled or accelerated by the use of real-time technologies?
What is recovered through the use of real-time technologies that was previously repress
What is displaced, reconditioned or replaced by the use of real-time technologies
What happens if the real-time technologies collapse and turn into the opposite.
SCENARIO REVERSES INTO
Since the year 2000 we are in the phase of human-centered design, within the historical development of medical products. In this phase the design focus is on the ease of use and on a high aesthetic appeal.
The use of processes, with the focus on interaction between people and objects, stand in the forefront of the design process and mediation – along with them the custom actions and explanation patterns which describe the communication, interaction and processes of the user (patient, physicians, orderly , etc. ). Due to the strong focus on the use, the value of medical products often appears in the use-process itself. Thus, especially the use of processes determine the perceived quality and the usefulness of medical devices.
The design of medical products, using real-time technologies, however, leads due to the technological conditions of real-time itself, to a paradigm shift in design and thus calls for an adaptation of design principles for designing devices which make use of real-time technologies.
The following insights, gained through this work, will greatly influence the focus of future developments for the design of medical products:
1 I Elimination of processes – Design and communication of results
Through the qualitative characteristics of speed and simultaneity of real-time, it is no longer necessary, as before, to communicate the process itself and use this to define products – it’s just about the design and communication of results. Processes are therefore largely irrelevant for medical products and appear often invisible for the user. The omission of processes focuses on the design and communication of the results: What counts is only the result and the appropriate form of mediation, not the process that leads to the result.
But not only for design solutions the elimination of the process means a serious change, even for the planning of products thus result changes, especially in the choice of methods, because part of the design methods, such as the (hidden / participative ) direct observation, expert interview, the development of questionnaires, the formation of focus groups, the persona method, role play and the user journey map for the study of user behavior and the corresponding processes get simply unusable.
Thus, it is necessary in the future to design a new set of methods that take the direct provision of results into account and refers to the appropriate communication channels and their interfaces.
2 I Focus of interfaces for exchanging biometric data
Back in 1991, Mark Weiser has formulated in his article “The Computer of the 21st Century”, the condition of the position as one of the most important requirements of “ubiquitous computing systems” in industrial environments. According to Weiser, it is a prerequisite that every computer needs to know where it is self-localized to adapt its interface and applications to the respective situations and the necessary requirements in an intelligent way. The position gets even more relevant, the more mobile solutions and human forms of life evolve in today’s environments, since all components that communicate a point of reference, need to be located and thus can be addressed. Issues of positioning occur in the foreground for data input and output and alternative interaction models are gaining importance. Humans are related to the surfaces of their interfaces of technical equipments and have to make unique positions in their communication.
By eliminating the process other, more direct connections between areas appear, that before because of the process itself, could not be joined together. In this context, the focus of interfaces becomes extremely relevant since the result processed and transmitted; the interfaces are therefore variously applied, as some sites require very accurate data entries for communication or tackling complex tasks, and others serve only for transferring or query parameters.
3 I New visual forms of communication for results of high information density
The enormous increase in the speed of results makes new visual forms of communication necessary because our perception of the usual designs in the form of for example texts, can not follow up with a hugh amount of information and we are overwhelmed while maintaining our current formats by future possibility of presenting results of high information density. By the simultaneous course of action and reaction, new forms need to be developed that are able to deal with distraction and attention. If everything appears at the same time, side by side, we do not sequentially read characters with concentration and a low attention (as in long texts), but only in fast reading. Therefore we need instruments that correspond and to the set of a hyper attention, while simultaneously extending several channels (such as with postings).
The principles for the design of medical products, using real-time technologies, are specified and validated in the following three concepts. All concepts use the setting of diagnostic imaging. The first concept describes the process of a mammography screening in real-time, the second concept deals with the human as an interface and the third concept is based on visual media in new and creative forms of communication for the future.
The manifestations and links for future digital systems will have to, especially in the medical field, match to the physical and mental abilities of their users. In particular, through enhanced sensor-driven applications people will serve as an interface with their entire body, which will be accessable at a digital space and could provide information or even be enriched with information from there.
For example, smart mobile devices will connect us for patient monitoring and use our data in a persistent content stream, to calibrate and evaluate the results automtically with the help of assisted algorithms. Rooms that are located within our home environment, turn into interfaces that cross-link us with other humans or systems through a unique body and spatial reference.
The human body is not able to connect with other systems to exchange data without tools. This means that it needs a sensor that processes data and information from the body, that can be transferred to other places. The sensor could for example be placed in form of a patch on the human body, so that it looks unobstrusively.
The back layer of the patch is provided with a microchip and an antenna which leaves it as a wireless digital transmitter, capable of transmitting real-time vital signs (heart rate, temperature , respiratory rate ) to applications without a mobile device carried by people, or that it is necessary to monitor the health status by complex monitoring systems.
This is useful especially for long-term monitoring, as the patient may remain in their familiar surroundings and can move there freely. The patch can be placed at different body areas – just where data is needed.
Furthermore it is conceivable that the plaster, enriched with a drug and controlled via a monitoring system could give an accurate dose of drugs to the patient which, depending on the results and comparison of the values, is adaptable and regulars drug proceeds automatically, for every individual person.
The progressive development of imaging methods in medical diagnosis has increased also measurement and control facilities over the last years. This increase generates large volumes of data that can not be displayed and evaluated in the future without some form of compression.
The associated expansion of the simultaneity of processes and information will change our actual forms of perception and mediation. Specifically, this means that the design of new forms of visualization, as a new visual culture, will inevitably be necessary in the field of imaging techniques in medicine, because today’s forms of pictures, graphics and texts are insufficient for the new requirements and high density of information.
This new form of visual design is working with the superposition of information and images from various process flows and handles them very compressed and concentrated.
To evaluate the obtained design principles, they should be applied in an exemplary experimental set-up for “Human Monitoring”. The tool of monitoring is required both, for many medical applications in the diagnosis and in the sports sector in order to monitor the state of the human body and its vital signs accurately. Various parameters such as pulse, breathing rate, body temperature, heart rhythm, blood glucose levels and blood pressure are interrogated by sensors. The monitoring is done in real-time as immediate, meaningful values in the most cases are obligate.
In the experiment, biometric data should be collected from the body, using an electrocardiogram read and interpreted in real-time.
The electrocardiogram (ECG) is a diagnostic tool to check the functions of the heart muscle. It is used to control the heart rate, applied to the rhythm of the electrical activity of the atria and ventricles. The ECG is an indispensable tool for the early detection of heart attacks and cardiac arrhythmias and provides important information on changes of the heart such as inflammation and abnormal loads, for example caused by drug effects.
Potential differences caused by the cardiac currents can be measured by discharges. In the experimental setup three electrodes are attached to the chest:
1. electrode ( Color: Pink) towards the right shoulder
2. electrode ( Color: Lavender ) towards the left shoulder
3. electrode ( Color: Blue ) left, lower hemithorax
The three electrodes are connected to a microcontroller interface, which via software, interprets the received data in real-time and produces a value or graphic element as output. A wireless communication with the interface is possible so that the patient has much more degrees of freedom, since he only has to carry the three electrodes, which are provided with a transmitter on the body without being wired. This is particularly interesting for patients who need to be constantly monitored, such as by long-term ECG.
The design of the electrodes with the material “felt” feel warm and so it is comfortable to wear them on the skin over a long period of time. Contrasting by three different colours the electrodes can easily be distinguished, so that they can be positioned by the patient himself.
The values that are detected by the sensors can be used and displayed in real-time a computer display or be printed out.
The ECG thus provides data that includes very detailed information, but for the use, especially by patients or relatives in their own environment, the informations are not optimally designed, especially in the context of real-time displaying them.
For this reason it is necessary to develop a new form of data interpretation, that allows a quick reading for not especially trained persons, to see the relevant results immediately. For the patient, primarily the heart rate is in monitoring relevant to see if he or she has shifts by a too high or too low heart rate and when this occurs exactly.
The information on the heart rate is represented by a pyramidal shape and the corresponding color. Each pyramid stands for one heartbeat.
Due to the current developments in medical products, within the next ten years it will be possible to measure or vital signs by ubiquitous sensors, which will lead to new functionalities and thus to new medical practices. This is not only confined to the physical, also mental states can be determined. The requirements for collecting and processing of large amounts of sensor data is to connect them in real-time, to make use of them for each individual person.
An increasing number of technologies is equipped with sensors which generate data that can be collected, shared and analyzed. The further development of sensors provides the necessary infrastructure for a network of intelligent interfaces and solutions that will allow us to monitor different, simultaneous processes and changes in the human body within the medical practice and care. Patients who today have to stay for a long time in hospitals or who have to live in a care facilitiy could stay in their own home and be observed and be accustomed there.
Thus, the locations of treatment and care will change as information and expertise can be called from everywher and there is often no need for inpatient monitoring, as real-time applications provide, through their permanent exchange of content, the possibility to be able to react immediately to problems if they occur.
Real-time can be described not only as an extension of digital products, but can be considered as a basic technique of the digital revolution, since real-time technologies (e.g. sensors) are particularly effective for the use of performance in technical systems and with the quality characteristics of timeliness and permanent update, digitized processes, meaningful support and complement data, could be helpful, especially in the medical field and in mind with the fact that society gets even older today and there will be a lack of medical assistence by people in the future because of that.
The development of wireless communication systems is currently driven by the Federal Ministry of Education and Research (in Germny) and is to come as close as possible to the physical limit of the speed of light ( 300,000 kilometers per second) in the near future. This development is already evidence on the relevance of the topic and the timely, comprehensive use of real-time technologies in all areas of life.
Due to the extremely high speed of future systems, the information will be denser. Therefore, it will become necessary to design new visual communication tools that can deal with these conditions and work best for the human perception.
The visual plays a major role in the real- time culture. We are experiencing an increase in resolution digital and the arise of complex visual media that can directly observe not only steady pictures but also motions inside the body in the future. The reinforced use of visual formats such as slices or real-time videos are conceivable in those scenarios.
Our new visual designs will have an fundamental impact on the perception of health, respectively, of our own image of the human body and how we experience it in medicine. The interactions between patients and doctors, and between the patients and / or family members will change significantly. According to a study by the Institute Pickert conversations with the doctor are counted very high and much higher than any other source of information – so this knowledge should be included in future medical product development considerations.
The delivery and prompt updating of data in time act as indicators of the quality of medical products using real-time technologies oand ptimize essentially the process of timing the diagnosis and therapy. By speeding up and processing results in real-time, completely new connections within treatment processes can occur and findings are related to each other.
Therefore real -time systems have to work very accurately and match with the user interfaces in the clinical practice to act effectively and produce informative data which is useful. The peripheries as well as media and input options that are needed have to satisfy needs that are satisfied until today only materially. In a transitional period, the use of physical files will co-exist before the products and equipment continue to recede into the background and become an abstract intermediate layer which allows access to standardized interfaces for everybody.
Processes remain in a systemic background. Only the results will be displayed prominently and will provide a seamless flow of treatments and therapy processes as well as organizational tasks such as patient registration and management. Thereby the boundaries between diagnosis and therapy will increasingly blurr, because processes are running and meshing simultaneously through the use of real-time transmissions.
Through the use of real-time technologies the design of medical products in the upcoming years will provoke exciting challenges for the design of medical devices to develop new forms of work, organization and maintenance. This work provides a possible approach and is considered as a medium to reflect on the relevant aspects of medical products in the future and our relationships with them.