' Personalized Healthcare Systems: Bandage-Sized Wireless ...



Framework: Integrated Healthcare

1 Introduction

Technology needs to interact with an individual as a whole: not just the different parts of an individual. I focus on developing a methodology for health technology design that considers interaction with this whole. A vision for an integrated health technology: integrated across disciplines and yet specific to human needs.

I present a conceptual framework to understand the influence of technology on individual healthcare. Towards this goal, I modify Wilber’s 4-Quadrant model to develop an integrated framework to understand an individual and his interaction with the environment. This framework is then used in the domain of healthcare to describe the interaction between health technology and an individual. By no means complete or sacrosanct, it encourages the reader to adopt an approach to technology design that considers an individual as a complete whole with a conscious and not just an empirical system. This benefits both: the designer and the user.

2 Integrated Framework

1 Individual Interacts

An individual can be modeled as a system that can be considered to be completely and uniquely specified by its state. The individual itself belongs to a hierarchy: being composed of sub-systems and being part of meta-systems. Figure * gives an example of one possible hierarchy.

2 State Changes

The individual undergoes state transformation due to his interaction with the environment or due to changes within himself. The state of an individual can be considered as the set of all properties associated with the individual at a given instant of time at a specific location. The space and time constraint are important to determine the context of the state. A modification of Wilber’s Four Quadrant Model can be used to classify the different properties that constitute the state. Wilber has used the model to integrate findings and conceptual insights from different disciplines to provide a Theory of Everything []. Based on the model, the different properties constituting the state of an individual can be classified based on the domain of observation. The domain of observation determines the domain of the individual under consideration: affective, cognitive, moral, interpersonal or spiritual. The domains of observation are not independent of each other and should not be considered as independent dimensions. For example, a change in the emotional change of an individual changes his cognitive state as well.

Each domain of observation can have different levels of observation. The level of observation determines the level of abstraction at which the individual is being observed: body, mind, soul or spirit. Each of the property at a specific level of observation within a particular domain of observation can have four components based on the mode of observation:

o Individual Subjective Component: The subjective observation made by an individual of his property due to its consciousness.

o Individual Objective Component: The objective empirical observation made by the environment of a property of an individual.

o Collective Subjective Component: The subjective observation made by the universe of a property of an individual due to the individual being part of a larger system: a collective consciousness.

o Collective Objective Component: The objective empirical observation made by the environment of a property of an individual due to the individual being part of a larger system.

Within each domain are four levels of observation, each having its four components depending on the mode of observation. Figure * provides a diagrammatic representation of the state of the individual based on the domain of observation.

It is important to note that the four components are manifestations of the same property and differ just in the mode of observation. Thus, a change in one of the components of the property changes the other components as well. For example, a change in the internal emotional state of an individual (individual subjective component) is reflected in the corresponding physiological change (individual objective component). Other individuals can understand this change if they have access to this change and share the same meaning for the particular emotion (collective subjective component). This collective understanding can also be sampled through a questionnaire given to these individuals (collective objective component).

3 Influence of Technology

Technology plays a role in this state transformation by changing the individual, its environment or the interaction between them. Thus the role of technology is multifold:

It can be used to change the form of interaction between existing systems and the constraints associated with the interaction. This changes the individual if the interaction influenced by technology is within him. If technology influences an interaction is within the environment, it changes the environment else technology changes the interaction between the individual and the environment.

It can be used to create new systems. This changes the environment and allows new interaction to happen between the individual and his environment. The new system can also be a channel of communication to interact with other entities in the environment.

Here the difference in the above two roles is small but philosophically important. When a new system is created using technology, the state associated with the system has different domains of observation and has the four components associated with each of the different domains. The presence of different levels would be dependent on the level of abstraction of the created system. The system is capable of interaction with the individual in the different domains: affective, cognitive, interpersonal, moral and spiritual. The realization of the capability and the extent of interaction in the different domains depend on the level of complexity of the system.

3 Integrated Health

A specific instance of the above framework can be used to describe an integrated model of healthcare as it relates to individual well-being. One can consider well-being as a desirable state (or a set of possible desirable states) of an individual with disease being a state transformation that takes an individual away from the state of well-being to a disease state. Here it is neither necessary nor possible to discuss the definition of well-being as it undergoes a change according to the time period and region under consideration. Thus every disease can be analyzed at different levels of observation in each of the different domains of observation. Each of the properties at a particular level and domain of observation would have four components depending on the mode of observation.

A solution based on the integrated model of healthcare would consider the changes associated in each of the four components at different levels of observation and in different domains for deciding a process of intervention. This solution should adapt itself as the spatial and temporal location of the individual changes. Table * lists some of the properties in the different domains and mode of observation that are important to consider when an individual has a disease. Here the discussion excludes the spiritual domain of observation, as currently there is lack of an understanding of the domain. Each property within a particular domain of observation has the four components as mentioned in the developed framework that are inter-related to each other. Based on the properties provided in Table * and the associated these transformations, one can try to determine the needs of the individual and design health technology based on those needs.

It is also to be noted that an individual is also part of a hierarchy. This hierarchy is the reason for the collective component of the properties. Thus it is important that an integrated health solution considers not just the individual himself in isolation but as a connected individual.

| |Individual Subjective | |Individual Objective |

|Domain of Analysis |Property | |Property |

|Affective |Emotions within an individual | |Affect on the physiological parameters in |

| |related to a disease and its cure| |the body and brain due to the disease and |

| |(I feel so depressed) | |the prescribed medicines (Change in heart |

| | | |rate) |

|Cognitive |Thoughts associated with the | |Affect on the cognitive and physical ability|

| |disease and its possible outcomes| |of the person due to the disease and due to |

| |(This disease is hard to cure. I | |the medicines (Change in the walking |

| |hope I get well) | |ability) |

|Interpersonal |Perception of the interaction of | |The interaction of the individual with other|

| |an individual with other people | |people in his social network and the |

| |in his social network and the | |physician as measured by the amount of time |

| |physician related to the disease | |spent, the written conversations etc (Take |

| |and its effect on the disease | |these medicines: 1, 2, 3) |

| |outcome (My doctor said I will | | |

| |get well. I think I will get | | |

| |better) | | |

|Moral |Individual value system | |Affect on individual behavior

| |Exploration A |Exploration B |

|Domain of Observation |Cognitive |Affective |

| |Interpersonal |Cognitive |

| | |Interpersonal |

|Level of Observation |Body |Body |

| | |Mind |

|Mode of Observation |Individual Objective |Individual Objective |

| | |Individual Subjective |

Chapter Perspective

1 Introduction

As an individual transforms, so does technology and its use. This transformation is reflected in the trends observed both in industry and in academia. I present the background work here for the reader to reflect on this changing trend in healthcare and develop a sense of the future: futuristic but placed in reality .

I present the background research in areas relevant to the thesis: academia as well as industrial (to the extent made public) using the integrated framework described earlier. It establishes the domains, levels and modes of observation present in the existing health technology and provides an overall perspective to the work done in this thesis. It gives a reason for the existence of my work: connection between the present and the future.

2 Overview

A change in the healthcare belief structure changes health technology design. The healthcare industry has been through three belief structures: the traditional belief structure, the transitional belief structure and the future belief structure. The three belief structures and their impact on health technology design have been presented in Figure 1,2,3.

In the traditional belief structure, the healthcare provider was considered responsible for the health of the individual through an approach of disease cure. The healthcare provider was the primary and only source of medical diagnostics, feedback and information with the role of the individual being of a passive patient and an information receiver. Health technology was designed for the health care provider with her being the primary consumer. The healthcare provider had the technological infrastructure and devices and used it to get information and prescribe a treatment and medication for the individual. It was driven by clinical healthcare with its focus on the individual objective mode of observation. The technology was towards improvement in the cognitive domain of the individual. An important shortcoming of such an approach was that it did not take into account the interior state of an individual.

In the transitional belief structure, the focus of healthcare shifted to disease management, the role of an individual became that of an active patient in the maintenance of his or her disease. The healthcare provider was the primary source of care and medical diagnostics but no longer the only source of information. There was an active process of dialogue where the individual had a say in defining and choosing the treatment. We had two different foci: the healthcare provider and the individual. The healthcare provider was still the focus for the design of health technology. She needed information over a period of time to help you manage the disease. He used his infrastructure and provided you with devices, he got the information and he had a dialogue with you about the treatment. Health technology was designed primarily for the physician with the aim to improve interaction between the physician and the individual. The technology was towards improvement in the cognitive and the interpersonal domain like telemonitoring systems. Here the interpersonal domain was restricted to being between the individual and the physician. The dialogue between the individual and the healthcare provider happened because the individual also had information. Technology from other domains was adapted by the individual for use in healthcare like the internet. The individual here was the focus. He needed the information, he used his infrastructure to get the information and used it to have a dialogue with the physician.

In the future belief structure (figure 3), the focus of healthcare changes to wellness, the role of an individual changes to being an active participant with the primary source of care at the individual’s environment. The focus shifts to the individual with the individual being the producer and the receiver of information. He needs the information, he uses the devices and he gets the information. It is for him to effectively use this information by sharing it with the physician for his wellness. The role of physician is for medical diagnostics and feedback.

Health technology is designed for use by the individual for his or her environment: home, office or car. The technology is to provide an experience to the individual that spans the different domains of observation. Thus, there is an expansion in the focus from improvement in the cognitive and interpersonal domains to other domains: affective, moral and spiritual. One can see this trend emerging with technology that is designed to combine different domains of the individual < like Extremity computing [] (the affective domain with the cognitive domain) or Relational agents [] (combination of interpersonal and cognitive domains) or Value Based Design []. Value Based Design broadens the design of health technology to the moral mode of observation and proposes embedded value systems>

|Premise |Healthcare providers are | |Diagnose and cure of a disease | |Healthcare providers get the |

| |responsible for maintenance | |is the basis for the | |information for the |

| |of individual’s health | |maintenance of an individual’s | |individual to help the |

| | | |health | |individual maintain her |

| | | | | |health |

| | | | | | |

|Implication |Technology needed by the | |Technology needed to diagnose | |Technology needed to get the |

| |healthcare providers to | |and cure a disease | |information for the |

| |maintain an individual’s | | | |healthcare providers |

| |health | | | | |

| | | | | | |

|Manifestation |Focus on technology for | |Focus on technology for | |Focus on technology for |

| |healthcare providers | |diagnosis and cure of disease | |information to be interpreted|

| | | |through physiological | |by the healthcare providers |

| | | |measurements | | |

Figure 1 Traditional Healthcare Belief System

|Premise |Healthcare provider is | |Management of a disease is the | |Healthcare provider get the |

| |responsible for maintenance | |basis for the maintenance of an| |information to help the |

| |of individual’s health | |individual’s health | |individual maintain her |

| | | | | |health |

| | | | | | |

|Implication |Technology needed by the | |Technology needed to manage the| |Technology needed to get the |

| |healthcare provider to | |disease | |information for the |

| |maintain an individual’s | | | |healthcare provider |

| |health | | | | |

| | | | | | |

|Manifestation |Focus on technology for the | |Focus on technology for | |Focus on technology for |

| |healthcare provider | |management of disease through | |information to be interpreted|

| | | |physiological measurements over| |by the healthcare provider |

| | | |a period of time | | |

Figure 2 Transitional Healthcare Belief System

|Premise |An Individual is responsible| |Well-being is the basis for the| |Individuals get the |

| |for maintenance of her own | |maintenance of an individual’s | |information to help |

| |health | |health | |themselves maintain their |

| | | | | |well being |

| | | | | | |

|Implication |Technology needed by the | |Technology needed for | |Technology needed to get the |

| |individual to her own health| |well-being | |information for the |

| | | | | |individual |

| | | | | | |

|Manifestation |Focus on technology for the | |Focus on technology for | |Focus on technology for |

| |individual | |well-being through continous | |information to be interpreted|

| | | |monitoring | |by the indiivdual |

Figure 3: Future Healthcare Belief System

Figure * lists some of the current healthcare technologies classified according to their domain of observation. The use of computers deserves special attention here. As discussed in the previous chapter, a computer is a separate system and based on the application, capable of interaction with the individual in all the different domains.

| | |

| | |

| | |

In the next section, we provide background research in the area of health technology directly applicable to the thesis: health technology related to wearable sensing, data visualization and social support. It provides a perspective to the work and how it can be considered to be on the edge of the trends in healthcare described above.

3 Health Technology for Wearable Sensing

Health Technology in the field of wearable sensing has rapidly evolved from isolated wired sensors focused on measuring one physiological parameter at a given instant of time to an inter-connected network of sensors capable of continous monitoring of multiple parameters. This change has been due to two factors. The first factor is the change in the focus of healthcare from disease cure to disease management and finally to wellness. The second factor is technological progress in areas like communication, sensing and algorithm design.

When the focus of healthcare was disease cure, a wearable sensor involved going to the hospital and wearing the sensor: like a ECG monitor! You would go to the hospital, place the electrodes on your body and have your ECG measured. You did not own one. Here the healthcare provider needed the information, she had the sensor and she got the information. Purely cognitive domain of observation.

As the focus of healthcare shifted to disease management, the second generation wearable sensing health technology developed, for example the holter monitor. The physician would provide you one so whenever you had a symptom, it would record your ECG for a specific time-period. This data can be later used by the physician to diagnose the specific cardiovascular disorder. Here the physician needed the information, you had the sensor and he got the information. The design of the wearable sensor was in the cognitive domain and the interpersonal domain. Here the interpersonal domain was restricted to the communication between the individual and the physician.

With the focus of healthcare being wellness, the third generation wearable sensors developed for wellness. A simple example is the heart chest straps that measure your heart rate, usually when you are exercising. Wearable sensing is increasingly being designed for use by the individual for himself or herself to be used in his or her own environment. Here you require the information, you have the sensor and you get the information. It is your decision to use it.

Sensors are also being developed that are part of the environment (smart home). The concept of smart homes [] is not discussed in detail here but an excellent review is available in []. The third generation wearable sensors are being designed with a functional specification that allows continous measurement of different physiological parameters over long periods. The system specifications of the sensors require them to be small, mobile, low powered and easy to use. It is not to say that one has been successful in the design of health technology that achieves all the targets but it is helpful to keep the specifications in mind to determine the limitations of a particular sensor. In the table given below, the work is presented based on the form factor (system specification) and the different functionalities present in them: sensing, communication, processing and power (functional specification).

Table * provides a overview of the different sensors based on the above classification.

|Form Factor |Implantable, watch [], jewelry [], apparels [], |

| |worn as separate sensors |

|Functionality: Sensing | |

|Functionality: Communication |2.4GHz [], specialized protocols like bluetooth [],|

| |ZigBee [], 802.11 [], cellular networks [], pagers |

| |[] to other frequency domains []. |

|Functionality: Processing | |

|Functionality: Power |Battery, body movements |

Sensors are available in different form factors ranging from being implantable to being a watch [], jewelry [], apparels [] or worn as separate sensors. This has provided a base for wearable sensors that in the future could be used continuously for long periods of time. Power has been a has major issue and battery life limits the continous use of sensors. There been development in the use of sensors that can derive power from body movements [].

Based on the communication architecture, the sensors differ in the use of the communication frequency (if they are wireless), the protocol for communication and the network architecture of the sensors. The communication frequency and protocol has varied from custom 2.4GHz [], specialized protocols like bluetooth [], ZigBee [], 802.11 [], * to lower frequencies of * []. There is an increased trend to use the unlicensed 2.4Ghz band or the existing network infrastructures like cellular networks [] and pager networks []. In most of the cases, the sensor connects to a base station. A major change has come in the ability of the base station to connect to the different networks around it using the computing devices present in its environment like the home computer of a person. The base station itself is being morphed with mobile electronic devices that an individual uses for his digital needs. Thus from an earlier design that used custom boards, the new wearable sensors increasingly use PDAs like Zaurus [] or iPAQ [] and cell phones []. This makes the system more integrated with the existing devices an individual may use and it makes it less susceptible to the hardware being obsolete.

Sensors are available for different measurements ranging from activity levels [], muscle movements [], pressure sensors [], heart rate sensors [], skin conductance [], blood pressure monitor, breath-monitor []. The focus here is on ECG measurement sensors. Table * provides the different sensors present that can measure ECG signals or more broadly heart parameters, their strengths and weaknesses.

|Project |Details | |

|Every Sign of Life [] |Data acquisition board that measures a 3 lead ECG using |Provides a portable 3 lead ECG but the |

| |electrodes |device is palm-sized so cannot be directly |

| | |worn on the chest. Invasive electrodes |

|Ring Sensor [] |A ring worn on the finger (skin contact) that uses a |Does not require the use of electrodes but |

| |photoplethysmograph to provide pulse data |only provides pulse rate so limited in use |

| | |for applications like stress detection |

|Chest straps by different companies [] []|A chest strap with 2 electrodes that provide 2 lead ECG |No connectivity to devices except those |

| |data |provided by the manufacturer |

|LifeShirt System (VivoMetrix Inc.) [] |A shirt with embedded carbon electrodes and inductive | |

| |plethysmographic sensors that analyze blood and | |

| |respiratory flows. | |

|SmartShirt (Sensatex. Inc.) [] |Sensors and circuitry embedded in a undershirt | |

| |Sensor pad containing hydrophone attached to user’s neck| |

| |that uses acoustics to measure pressure changes. | |

| | | |

| | | |

At the time of my first exploration, there were few wireless ECG sensors capable of measurement of 3-lead ECG. However the need for effective home care solutions for medical monitoring of individuals together with development in the area of wireless communications especially bluetooth has led to a rapid development in the area of ECG sensing.

Although there is an increased trend towards connectivity of the sensors, the focus of the present research is the interaction between the individual, his inanimate environment and the caregiver. My first exploration as described in Chapter * was a step in the design of a sensor network that breaks this connectivity divide using a wireless 3-lead ECG sensor? Can a wireless sensor be designed that measures 3-lead ECG? Can it be as small as a bandage? Can I connect it to other bandages? I designed a wireless 3-leadsensor that can communicate over a range of hierarchies of which an individual is a part to provide integrated health monitoring. Due to a lack of time and shift in thesis goals>, the sensor was not used for experimentation. The innovation I feel is not just in designing an ECG sensor but the consideration of its future use.

4 Health Technology for Social Support

The interpersonal domain of an individual, specifically other individuals with whom he or she interacts (his or her social network) play an important role in the health of the individual. The social support provided by such individuals range from providing health information to being a caregiver []. A majority of this health-related social support comes from close friends and family members, the physician or thematic communities (individuals with similar health problems or issues) [].

When the focus of healthcare was disease cure, the interpersonal domain relevant for clinical healthcare consisted of the interaction between the individual and the physician. Since the individual was a passive patient, the exchange of information was ‘ask for symptoms and provide medication’. This too was kept strictly under control like the color of the hospital environment and the conversation being strictly disease related. Thus the role of health technology in this domain was limited to using the phone as a communication medium to set up appointments or ask for advice from the physician.

As the focus of healthcare shifted to disease management and the role of the individual increased, two different phenomena can be observed. Health technology was designed to improve the interaction between the physician and the individual. An example is telemonitoring systems. You needed to give the symptoms from home, the physician required the information so a system was set up to provide a communication channel for such information. Here the focus was the physician. Simultaneously the individuals adapted technology from other domains for use in healthcare. This increased the information available to the individual. For example the use of internet by the individuals and by their caregivers in healthcare for information and content, developing thematic communities and support groups, e-commerce and communication between existing individuals [].

However the focus of the present research has been on the use of computers and internet in improving the interpersonal domain, especially the interaction between the individual and the caregiver. Less importance has been given to the design and evaluation of health technology that aims to change the interpersonal domain of an individual with respect to friends and family members.

As the focus of healthcare shifts to wellness and the individual becomes the center of information, it becomes important to have health technology where the focus is not just inter-connectedness between the individual and the physician but also between the individual and the friend and family member. My second exploration focuses on this shortcoming and a health technology is designed and evaluated for its effect on the interpersonal domain between an individual (person with diabetes) and a friend or family member who the individual considers as being instrumental in providing support in managing his or her diabetes. What happens when a friend or family member instantly knows about the blood glucose level of the person with diabetes? Are they even interested in it? Do they help him or her more once they know it?

5 Health Technology for Data Visualization

Effective visualization of complex data is required for it to be efficiently understood without any major cognitive or affective load. Ever tried to read a badly organized map and got frustrated? It is to be realized that here it is the complexity of the data as perceived by the individual and not by someone else. An engineering drawing may be complex to a musician while a music composition may be complex to an engineer (barring engineers who are music literate and vice-versa).

As the focus of healthcare shifts from disease cure to disease management and finally to wellness, it becomes more important to be able to quickly relate data from various physiological parameters over long periods and derive information from it.

Earlier for disease cure, it was sufficient for the physician to look at a series of physiological tests at an instant of time and prescribe medications accordingly. Here the physician needed to analyze and interpret information about one individual using one time set of measurements. He had the required training for interpreting the data presented in medical terminology and could interpret the technical data.

In disease management, this shifted to the need of being able to look at the patient history, probably compare it with other patients and then prescribe an effective treatment. The treatment changed as the condition of the patient changed over a period. This increased the cognitive load on the physician. The need to reduce this cognitive load has led to development of visualization systems for health information like patient records []. Here the focus is on the physician who has to view a large amount of data and importance is given to the layout and presentation of the data rather than abstraction of the data itself. From the physician side, this is understandable as he or she is used to having the data in a specific format and needs to interpret the data for diagnosis. Though the individual is also receiving some of this information, he or she is presented the information in the same format as the physician. It is difficult for the individual to interpret this data. Ever tried reading the results of a test report?

However as the focus of healthcare shifts to individual wellness, the individual becomes the center of information who has to understand and act on this information to maintain his or her health. A physician cannot be present with the individual 24/7 to help interpret the data and provide information. It then becomes important to present the health data to the individual in a way that it is useful for him or her. This requires reduction in the complexity of the data and abstraction of the useful information in a way that is understood by him or her. Also the data needs to be presented to friends and family members who may be even less knowledgeable in the interpretation of the data than the individual himself.

For an individual, the ECG waveform is just data (as compared to being information) that one is not capable of interpreting (most of the times). It is more useful for him or her to know if his or her ECG has any possible symptoms of cardiovascular diseases, the relation of his or her activity to the ECG etc. He or she may acquire the knowledge over a period to interpret even the waveforms. It is less likely that his or her friends and family members will simultaneously acquire the knowledge. For them, it is more important to know how the individual is doing, how ‘well’ he or she is.

Another focus of my second exploration is based on this need: data visualization for the individual and to his or her friend of family members. What are effective ways of presenting blood glucose levels to a person with diabetes so it can be easily interpreted by him or her? What are effective ways of presenting the same blood glucose level to a friend or family member of the individual so he or she knows how his or her dear one is doing?

- end –

Conclusions

Evaluation

Technology feeds on itself. Thus it accelerates change. The change itself is the cause of disease as it requires the human to adapt to new surroundings. This affects wellness. But technology also allows the system to change from its state of being unwell. By allowing it to adapt to the adaptation and that is what is happening. When you have a symptom of stress: a lot of times the stress is due to technology but you can employ technology to reduce that stress? That health technology needs to take that inoto account. It itself is the cause and the effect like any other technology.

What does it mean if an agent becomes the cause as well as the healer. It needs to be reconiged on what sideo f the change the technology is being used for? Is it healing or is causing a rupture?

Simplicity in Complexity

Here is the crux of the technology design: the complexity was created by the technology nad now the design needs to focus on the simplicity. So integrated technology is headed towards simplicity of complex systems, that are evolving and becoming more complex and more simple

Stability in Change

Systems change so you can adapt so you don’t have to change you are stable. Its like the neuron function

Technology Design

It

Technology Design suoitable for the three trasformation vectors. Integrated health defines the need and the three vectors define the constraints.

Future:

Change:

Adrenalin page 336

Choice: Increasingly philosophically it is the development of the consciousness and the individuals at a whole going to a higher dimension of self. Economically it means consumerism ewhere the consumer has th power.

Time: The time for dissemination of information shortens.. it will continue to shorten until it becomes seamless. The lag between the when a medica dosciery happends and when it gets to the consumer is reducing and it wil icnresingly be up to the consumer to make the choice and not the healthcxare delivery system. The system can no longer take decisions for the individual: rather it can but One has to choice to override it

Case of AIDS vaccine (was it AIDS) being released for a specific subculture (I think it was African-american) inspite of the Fda initially banning it due to deaths

Glaxoline example from Prahlad

Experiencsim: physcholozation of the technology. This again indiates movement towards a higher dimension to the mind where intangible experiences play an important role than the functionality: in my case inspite f the installation problems, people loved the device. Why ???

Space:

More specific to the case study:

People are aware of their needs and they want a solution. They are also aware of the

Atechnology (??? Really)

,

Technology Design

Technology design itself can help accelerate that change by bringing in mechanism that individuals can and should use to reduce change

Direct change:

Stability Zones: Can technology create a sense of permanence or is doomed for obsoletion. People hangon to old things, can they hangon to old technologies? IF they can, can it be used as a mechanis, to reduce stress by changing technology in a way that it brings silient transition into the lives of people. One morning you wake up an are in this ssmart homes who knows about you, cares about you, does everything for you. The impact might not be completely pleasant. One needs to transtion it where it is like a relationship so when you are develping a sensor,

Human side effects of technology design (taming technology) 438

Affect on the vlau system

References

Appendices

▪ Appendix A: Bill of Materials for ECG Sensor

▪ Appendix B: Circuit Diagrams

▪ Appendix : Study Recruitment Materials

▪ Appendix C: Study Consent Forms

▪ Appendix C: Study Questionnaires

▪ Appendix : Response to Questionnaires

▪ Appendix D: Installation Sheets

▪ Appendix E: Instruction Sheet for the participant and family member

▪ Appendix F: Study Expenditure

▪ Appendix G: Follow up Study Expenditure

▪ Appendix E: Bibliography

end –

Work in Progress

Abstract

Thesis Readers

Acknowledgements

Table of Contents

WHAT IS THE PROLEM?

Introduction

Current healthcare system has problems:

• Aging population

• Chronic Illnesses

• Knowledge Base of the internet and technological advancement

This requires solutions:

• Individual Centric approach to healthcare and promoting self-care

• Focus on Prevention rather than just cure

• Long Term analysis rather than just short term predictions

• Looks at the different sources of healthcare management other than just medicinal cures likes social networks

Thesis focuses on such a solution:

• Integrated approach to healthcare

• Development of an effective health wearable that has a flexible hardware architecture

• Uses technology to facilitate social support and uses the structure of the social network

Introduction

Motivation:

Scene 1: Ayurveda ??

Scene 2:

Scene 3

Emerging Trends

Changing Needs

New Healthcare System

Aim of the Thesis

Background

Sociology: Social Support

Medicine: Diabetes Management & Chronic Disease Management

Electrical Engineering: Wireless Sensing

Computer Science: Learning Systems

Machine complexity

Mind conciousness

Related Work

Commercial Healthcare Systems

Academic Healthcare Systems

Proposed Health-Zero System

System Architecture

Bandage Sensors

Analog Sensing

Communication: RF Communication (Reason for choosing RF communication)

Power Consumption

Design Advice: Failures and Successes

The Future of Bandage Sized Sensing

Conducted Experiment

System Description

Hypothesis

Experimental Method

Results

Discussion

Future Work: Follow Up Studies

Future Directions

Conclusions

References

Theoretical and Practical Implications

Sociological and Philosophical Implications

Future Directions

Conclusions

On-site Subject Experience Materials

Data Analyses and Related Documents

References

Biographical Note

Scene 1: Time: 1985 Coordinates: Planet Earth, (

Young Population

Diseases that are cured

Doctor Rules

Medical Care Cost

Number of Doctors Per Unit Population

Baby Boomers: What Happened to Healthcare for Pediatrics

Scene 2: Time: 2000 Coordinates: Planet Earth (40 – 50 years old baby boomers)

Aging Population

Rising transient diseases

Lifestyle distinct from Health

Symptom Based Approach

Medical Care Cost

Number of Docs Per Unit population

Young Population

No risk evaluation

Scene 3: time 2025 Coordinates: Planet Earth

Aged Population

Transient diseases

Prevention Based Approach

Right ‘Lifestyle’

Risk Evaluation based on lifestyle

Symptom Based Approach

Medical Care Cost

Number of Docs Per Unit population 1:1 virtual real 100: 1

Young Population

Instantaneous Information Available

Learning Systems

Personal Doctors

Get AARP involved and ask then about what they think of a possible introduction

Certain trends are clear in terms of the above scenarios that are different from the current healthcare infrastructure. To prepare to that we need a new approach to healthcare which will have certain distinct features namely:

Key Trends

Why those trends are valid and important?

Background Work in Healthcare and Social Support

Diabetes Self-Management

Wireless Devices

Needs that arise from those Trends

How the current healthcare devices do not meet those key needs

What the thesis accomplishes to do:

Proposed System

Provide feasibility and proof of concepts in key areas

Establish distinctly the identified needs, key areas, proposed solution and its result

Need for a distributed sensor network of bandage-sized sensors

Need for technology to understand the social interaction

Need for effective visualization tools (information processing) (reducing complexity of systems rather than increasing them)

Need 1: Bandage Sized Sensors

Need 2 & Need 3: Conducted Experiment

Other Needs that have been solved by others

Conclusions

References

Health Zero proposes to such an approach.

Key pieces to the puzzle approach – some I solved some have been solved by sandy

Abstract

Thesis Readers

Acknowledgements

Table of Contents

WHAT IS THE PROLEM?

Introduction

Background

Currently Health System

Problems in the current health system

Changes in the way of information processing

Related Work

Social Networks

Health

Focused Problems that I am trying to solve

- wireless sensing

- social networks and technology

how social networks play a fundamental role in providing support for chronic disease management and how technology can play an affective role in strengthening the information flow in a social network

The social network can also be altered by the mediation of technology

The Solution

Proposed Architecture

Hardware Architecture

Software Architecture

Social Support and Diabetes

References

Biographical Note

WHY IS THE PROBLEM IMPORTANT?

Intensity of the Problem

TO WHOM IS IT IMPORTANT?

HOW AM I GONNA SOLVE IT

Personalized Health Care Systems

WHAT IS UNIQUE ABOUT THE SOLUTION

ACTUAL IMPLEMENTED SOLUTION

IS IT EXTENSIBLE

BIBLIOGRAPHY

BACKGROUND TO THE PROBLEM

-

Social Networks & Health

Social Networks and Diabetes

Diabetes Care and Self-Management

Sensing

Visualization Tools

Measures

Demographic Data Recording Form

Social Support Form

Self Care Inventory

Device Usage Form – Personal

Device Usage Form – Family

Chapter

Economic Theory:

Thus developing a system would involve clearly defining the state od

Chapter Case Study B:

DELETED STUFF

From influence of technology:

A computer is a new system created using technology while internet changes the interaction between existing systems (computers). It is capable of interacting with an individual in the different domains based on the software it is using. The moment we say that a computer is a system, it then raises questions of the internal state of the system. It is not possible to delve deeper into the question but one can consider that the computer is of a level of complexity where the observed behavior itself is predictable and deterministic and the interaction can be based on that deterministic behavior. Every internal state has been mapped to its corresponding external state.

In the future, one will reach a point where technology can be used to create systems of complexity that surpasses an individual. This will create an entire new structure of conscious machines coexisting with individuals []. Though beyond the scope of this thesis, it has its implications where one can imagine an environment of individuals and machines, each having its own value system, culture and emotions.

In the next two subsections, I explore two particular cases: old age and diabetes. We examine the state transformations that occur due to old age and diabetes.

In the next two subsections, I explore two particular cases: old age and diabetes. We examine the state transformations that occur due to old age and diabetes.

| |Traditional Healthcare |Present healthcare |Future Healthcare |

| |Delivery Model |Delivery Model |Delivery Model |

|Goal of Interaction |Disease Cure |Disease Management |Wellness |

|Locus of Interaction |Once when symptoms |Periodic |Constinous |

| |developed for the diease | | |

|Pattern of Interaction |Passive, |Active | |

| | | | |

| | | | |

| | | | |

| | | | |

|Curing diseases is the basis for the|Healthcare providers are |An individual needs a healthcare |

|maintenance of an individual’s |responsible for maintenance of |provider to cure her disease |

|health |individual’s health’s | |

|Technology is needed to diagnose and|Healthcare providers use |Healthcare providers get the |

|cure the disease |technology to help maintain an |information to diagnose and cure |

| |individual’s health |the disease |

|Focus on health technology for |Focus on technology for healthcare|Focus on healthcare providers |

|diagnosis of disease through |providers |using the health technology |

|physiological measurements | | |

|Healthcare providers are responsible for |Healthcare providers get the information |

|maintenance of individual’s health’s |for the individual to maintain her health |

|Healthcare providers needs technology to |Technology needed to get information to |

|help maintain an individual’s health |the healthcare providers |

|Focus on technology for healthcare |Focus on technology for information to be |

|providers |interpreted by the healthcare providers |

|Premise |Healthcare providers are | |Diagnose and cure of a disease is the | |Healthcare providers get the |

| |responsible for maintenance of | |basis for the maintenance of an | |information for the individual to help|

| |individual’s health | |individual’s health | |the individual maintain her health |

| | | | | | |

|Implication |Technology needed by the healthcare| |Technology needed to diagnose and cure | |Technology needed to get the |

| |providers to maintain an | |a disease | |information for the healthcare |

| |individual’s health | | | |providers |

| | | | | | |

|Manifestation |Focus on technology for healthcare | |Focus on technology for diagnosis and | |Focus on technology for information to|

| |providers | |cure of disease through physiological | |be interpreted by the healthcare |

| | | |measurements | |providers |

Triology Part I

o Introduction

§ Hype Cycle

(Just describe the scene don’t analyze here, do the analysis in the last part)

§ Scene 0: 1980s

§ Scene 1: 1998

§ Scene 2: 2004

§ Scene 3: 2008

§ Scene 4: 2010 ?

o Trends Observed based on the above hype cycle (not sure which order they be presented in)

Business vectors (Globalization etc)

Sociological vectors (Nuclear families, Work home infusion, global families)

Technological vectors (rapid convergence, access, profusion of intelligent mobile devices etc)

Transformatios show them ona graph: increasing complexity of technology, distribution, personalization.: they have to handle complexity themselves and change.

They have to adapt to changing complexity !!! there lies the problem

Toffler talks about it.

Complexity to adapt to change is what should be the aim.

increasing diversfication and increasing

and that is what we will be doing here

o Trends driving towards a major change. I analyse this change in the domain of healthcare

• Motivation

• Motivatio

o Reason for me writing this thesis

o Methodology:

o To be written based on One must still have chaos in oneself to be able to give birth to a dancing star !!!

o Health Zero

Health Zero is about a vision of …. One paragraph stuff

• But first we need a framework for analysis – a few defitions that provide meaning to the exploration. This not to say it was guided by them fo rthey developed in parallel and both are evolving like technology

•

• Theoretical Framework for Analysis

o Roadmap of Experiments

o Perspective(how the experiments fit and what parts they are trying to validate of the Health zero)

the epxlrations are the way to explore the process of design of integrated tehnology: what does it mean for a technology to be desgined for experience: what are the possible business transformations.

The need of healthcare (integrated healkthcare) -> integrated technology & integrated business. & integrated society.

Triology Part II:

Here I am unclear of how to present the case in a way that it connects to the things in the introduction. I do analyse it according to the framework.

A: exploaing experience in the cognitive and intepresonal domains.

Exploration A

Description

Small Analysis and Critique

Conlclusion(in terms of what you set out to do in health zero framework)

How the experiment showed changes in the economic, social and technology vectors

Due to the device,,,

Exploration B

Description

Small Analysis and Critique

Conclusion(in terms of what you set out to do in health zero framework)

How the experiment showed changes in the economic, social and technology vectors:

How the experimented validated the changes and how the technology design based on that

Due to the device,,,

Triology Part III:

Evaluation and Critique: Broad Implications of the healthcare system of future

How it would entail,

Revisit the scenes described in the first triology and try to see how the value creation might happen.

Economic value creation

Sociological value creation

Technological value creation

Reality Bytes from things which suggest this will happen

Conclusions

Appendices

TRILOGY PART IV: There is no beginning and no end..this world is just a morbius strip.

Transoformations Happening due to which there is the problem of adaptability to complexity of humans is limited and this causes health problems

When we explore the cause of health problems then onny can bwe focus on wellness. If we reduce the causes rather than the symptoms

The case studies are an insight into how one can design integrated technology to solve the problem of adaptability to complexity: the solution: complexity to adapt

Explore the interaction to give insights into the cause of the problems in interactions and the good features.

Evaluation is on that:

akshay_mohan (12:02:56 AM): hieee there

umakant_soni (12:03:27 AM): hi

umakant_soni (12:03:43 AM): so where is your thesis now..was just reading your email.

akshay_mohan (12:04:07 AM): pretty good.. i just thought of a good way to describe the background section..

akshay_mohan (12:04:21 AM): if you have time, i can send it to you and you can read it...

akshay_mohan (12:04:37 AM): its based on Prahalad's model of value creation

umakant_soni (12:04:45 AM): enlighten me

akshay_mohan (12:04:49 AM): ?

umakant_soni (12:05:02 AM): oh...cool..so you finally found use of prahlad's book

akshay_mohan (12:05:12 AM): oh yes.. its a cool book

umakant_soni (12:05:20 AM):

akshay_mohan (12:05:45 AM): hey i have a qestion: so he gives examples of various real life studies, now if i want to make use of them so i dreictly qute the study or quote him

akshay_mohan (12:06:17 AM): ? you can see i have lost my ability to type tired out

umakant_soni (12:06:40 AM): of such a system..and where all the value will be getting created that will be making such a system viable.

umakant_soni (12:06:50 AM): mail me your thesis...I have some time today..can go through it...

akshay_mohan (12:07:03 AM): am doing it now.. it has the four major chapters...

akshay_mohan (12:08:00 AM): such a system..and where all the value will be getting created that will be making such a system viable. ????

umakant_soni (12:11:16 AM): One thing is that ..you can extend his case studies...

umakant_soni (12:12:05 AM): and then quote that original framework of the case study came from prahalad.

umakant_soni (12:13:05 AM): I guess it might help you to work out all aspects of economics...of such a system..and where all the value will be getting created that will be making such a system viable.

akshay_mohan (12:13:17 AM): have sent you the email

akshay_mohan (12:14:38 AM): that might take too much work

akshay_mohan (12:14:52 AM): it will be cool if I can do it for my case study

umakant_soni (12:15:36 AM): yah...btw..do you know of the experiment Pentland and his team were doing in india using 'palmtops' ....of medical information management for rural people...

akshay_mohan (12:16:00 AM): yup

umakant_soni (12:16:04 AM): there is a nice paper on it...that they presented in Dyd02 ...search on the net and find it..

umakant_soni (12:16:28 AM): since he is a reader for your thesis..I guess he might have important questions to ask you..

akshay_mohan (12:16:57 AM): yeah bue he is out of country

umakant_soni (12:17:35 AM): cool..

akshay_mohan (12:18:41 AM): so he doesn't have many comments else would have loved it

umakant_soni (12:19:48 AM): Can you include a futuristic story board describing one such senario..and analyse it..from your framework...just a suggestion..drop it if you dont have time..

akshay_mohan (12:20:27 AM): but yeah the thing about economic value you said is nice. so if you have any specfic suggestions that will be awesome. One thing is that I do want to have a economic value case so i can use this thesis as a way to enter prodcut design companies including Lunar

akshay_mohan (12:20:46 AM): do you have suggestions for the furistic theory...

akshay_mohan (12:21:26 AM): maybe i can cowrite that chapter for you

umakant_soni (12:21:41 AM): Well..I would have loved to have a doglas adams kind of commentary of such a system...

umakant_soni (12:21:56 AM):

umakant_soni (12:22:31 AM): where you describe one such day in the life of Mr. Adams...on the planet earth..and his daily interaction...and how exactly the value get created for him..

akshay_mohan (12:22:38 AM): no seriously i can include that in the thesis.. that will be cool.

umakant_soni (12:23:23 AM): it greatly aids visualization and at the same time...makes it easy for VCs to know if there is something cool down there..

akshay_mohan (12:26:17 AM): when you say 'value created for him' something like th experiential value that prahalad (and also toffler) talks about?

akshay_mohan (12:26:31 AM): where would you put it in the beginning?

akshay_mohan (12:27:20 AM): i was thinking of three scenarios, from life of mr adams in different eras

akshay_mohan (12:27:33 AM): but I am not sure about the best way to present the case

umakant_soni (12:27:35 AM): Now I think, I would put two storyboards...one describing the present system..and another one describing the future system..

akshay_mohan (12:28:00 AM): 1980 (without internet), now and 2010

umakant_soni (12:28:14 AM): have you ever written a business case ...of a problem

akshay_mohan (12:28:19 AM): nops

umakant_soni (12:28:51 AM): No to work with VCs....I wont put...2010...but 2008..

akshay_mohan (12:29:04 AM): ?

umakant_soni (12:29:16 AM): also draw up a hype cycle ...if you know about hype cycles...about how this evolution will happen..

akshay_mohan (12:29:24 AM): hype cycle?

umakant_soni (12:29:48 AM): have u read a case ...I guess they use it in MIT sloan..just write one like that..

umakant_soni (12:30:20 AM): yah..when we present new technologies...its adoption and assimilation cycle is called hype cycle..

umakant_soni (12:31:16 AM): so how it will span from now to 2008...will be one diagram...

umakant_soni (12:31:35 AM): that will put a better background to your thesis..

akshay_mohan (12:31:36 AM): so the hype cycle will be from 2004 - 2008?

umakant_soni (12:32:07 AM): nope..it will be from 1999-2008 and beyond ...

akshay_mohan (12:32:10 AM): what kind of change do you expect in four years.. i just think the technology we have now will mature more in terms of them being personalized and yet integrated

umakant_soni (12:32:28 AM): I will just mail u one such diagram..

akshay_mohan (12:32:44 AM): ok i don't think i am completely getting the point you are making about 1999-2008, is it seperate from mr.adams?

umakant_soni (12:33:30 AM): nope..it isnt..It links...the thesis and the real life..

akshay_mohan (12:34:17 AM): so you are talking about say three phases in the life of mr.adams 1999, 2004. 2008?

umakant_soni (12:35:22 AM): i mailed you...check fig1 ...it helps describe the evolution of the system in terms of time scale..

akshay_mohan (12:35:44 AM): if you have the analogous business case, please mail me that too.. tht will be cool

umakant_soni (12:35:50 AM): Mr. adams is a snapshot in the evolution cycle take at 1999 ...2004 and 2008..and beyond..

umakant_soni (12:35:58 AM): sorry taken at

akshay_mohan (12:36:21 AM): ?

umakant_soni (12:36:37 AM): I just misspelled...

akshay_mohan (12:36:44 AM): which email did u sent it at? iinvent?

umakant_soni (12:37:37 AM): yah

akshay_mohan (12:38:15 AM): didn't get it until now

akshay_mohan (12:39:22 AM): try sending it again at iinvent@mit.edu

umakant_soni (12:40:53 AM): wait..it might take a bit of time..u will get it..

akshay_mohan (12:43:15 AM): okeee. send me a business case too..

umakant_soni (12:43:18 AM): brb...going to get coffee

akshay_mohan (12:51:04 AM): so i found that gartner has a report on the hype cycle for healthcare technologies.. i can try to use parts of it

akshay_mohan (12:57:55 AM): it will be cool if you give me your dream table of contents for my theis.. or what would a VC like... that woudl simply be aweomse and owuld help me a lot

akshay_mohan (12:58:07 AM): found the gartner repoert

umakant_soni (1:13:49 AM): tell me the title..I guess..u might need to buy it...I have corporate access..can help y

akshay_mohan (1:13:59 AM): MIT has access

akshay_mohan (1:14:39 AM): the title was Hype cYcle for healthcare provider technology 2003

akshay_mohan (1:15:30 AM): so you are commending making a Hypecycle for Healthcare Technology in general?

akshay_mohan (1:15:35 AM): recommending*

akshay_mohan (1:16:30 AM): and how do i estimate where the technology lies? just rought assumptions based on research?

umakant_soni (1:17:14 AM): cool..

umakant_soni (1:17:16 AM): based on that..make a hype cycle of your own...and plot the technologies..that will form the foundation of your future healthcare system..

umakant_soni (1:17:30 AM): that should make your future system a lot sounder

akshay_mohan (1:17:54 AM): hmmm.. So when you say future healthcare system, you mean wrt consumer technologies right?

akshay_mohan (1:18:10 AM): and you recommend writing a seperate chapter for it?

umakant_soni (1:19:37 AM): nope..I would recommend build on it...and link it to your description of factors that will aid that and sort of come out of pragmatic adoption pattern for it..

akshay_mohan (1:20:26 AM): hmm.. if possible can you write me your dream table of contents for the thesis.. that will be awesome

akshay_mohan (1:20:49 AM): and would really help me understand... that is the single biggest thing i need to do.. connect everything together

akshay_mohan (1:36:52 AM): you there?

umakant_soni (1:37:58 AM): hang on..had a telephone call

akshay_mohan (1:38:13 AM): sah

akshay_mohan (1:38:15 AM): ah

umakant_soni (1:42:04 AM): Dr. H. S. Rana M-56, Sector 11, 9 B Main Jeevan Beema nagar, Bangalore 75

akshay_mohan (1:42:11 AM): ?

umakant_soni (1:42:12 AM): oops

akshay_mohan (1:42:15 AM):

umakant_soni (1:43:56 AM): hey do u know about autonomic computing...

umakant_soni (1:43:59 AM): from IBM...

umakant_soni (1:44:11 AM): they are designing systems that can doctor themselves

akshay_mohan (1:44:25 AM): interesting

umakant_soni (1:44:32 AM): or if they are ill ...they spread the news and they get treated...

umakant_soni (1:44:44 AM): hey ask your brother...I bet he would know a lot about it..

umakant_soni (1:45:03 AM): type in google...autonomic computing and IBM...

umakant_soni (1:45:10 AM): they have a paper on it..

akshay_mohan (1:45:27 AM): hmm.. will look...

umakant_soni (1:45:30 AM): I guess...what we would be coming up with in future would be autonomic people

akshay_mohan (1:45:55 AM): yeah.. i definitely think it is more than just a possiblity. its a reality

umakant_soni (1:46:06 AM): people who are able to treat themselves for a variety of symptoms, without needing intervention..

umakant_soni (1:46:17 AM): and lot of intervention would be preventive one..

akshay_mohan (1:46:21 AM): yeah

akshay_mohan (1:46:22 AM):

akshay_mohan (1:46:35 AM): hey you should definitely to write me a Table of contents

umakant_soni (1:46:38 AM): Scene 1: Time: 1985 Coordinates: Planet Earth, ( Young Population Diseases that are cured Doctor Rules Medical Care Cost Number of Doctors Per Unit Population Baby Boomers: What Happened to Healthcare for Pediatrics Scene 2: Time: 2000 Coordinates: Planet Earth (40 - 50 years old baby boomers) Aging Population Rising transient diseases Lifestyle distinct from Health Symptom Based Approach Medical Care Cost Number of Docs Per Unit population Young Population No risk evaluation Scene 3: time 2025 Coordinates: Planet Earth Aged Population Transient diseases Prevention Based Approach Right 'Lifestyle' Risk Evaluation based on lifestyle Symptom Based Approach Medical Care Cost Number of Docs Per Unit population 1:1 virtual real 100: 1

akshay_mohan (1:47:19 AM): i like it

umakant_soni (1:47:52 AM): I guess...in these scene ..you can put Mr. Adams...days...and link all the scene around the hype cycle..describing all the developing technological, business and social vectors that will propel towards these scenes

akshay_mohan (1:48:36 AM): explain this more... what you mean when you say link all scences around the hype cycle?

umakant_soni (1:49:23 AM): yah..tell that these scenes are snapshots of the actual world's adoption ...they are points in the hype cycle..

akshay_mohan (1:49:59 AM): and what you mean by social vectors that propel towards these scenes? virutualization ?

umakant_soni (1:54:39 AM): social vectors are changing social structures due to technology...future shock describes it very well

akshay_mohan (1:54:52 AM): okee.. yup

akshay_mohan (1:55:00 AM): hey do write me a toc...

umakant_soni (1:56:34 AM): hey..I am sure...I do have all the knowledge to write the whole one..give me a tentative and I can react to it a lot better...

akshay_mohan (1:56:58 AM): okeee... give me 20 mins or so

umakant_soni (1:57:37 AM): sorry...i had meant to say....I donot have .....man..I have got your bug too...

akshay_mohan (1:57:52 AM): ???

umakant_soni (1:58:48 AM): of misstyping...

akshay_mohan (1:59:10 AM): no.. what were you trying to say?

umakant_soni (2:01:22 AM): hey..I am sure...I donot have all the knowledge to write the whole one..give me a tentative and I can react to it a lot better...

akshay_mohan (2:02:02 AM): ah.. okee give me 15- 20 minutes

akshay_mohan (2:05:02 AM): i want to present the thesis like a triology

akshay_mohan (2:05:13 AM): three parts to the whole thessi

akshay_mohan (2:05:16 AM): thesis*

umakant_soni (2:05:38 AM):

umakant_soni (2:06:00 AM): like matrix

umakant_soni (2:06:06 AM): or kill bill

akshay_mohan (2:06:25 AM): yeah

akshay_mohan (2:06:45 AM): like matrix except in the end there is a note of how everything is connected so there is no end , no beginning

akshay_mohan (2:06:50 AM): one continous 'chakra'

umakant_soni (2:07:49 AM): humm....like mobius strip...

akshay_mohan (2:08:05 AM): ??

umakant_soni (2:08:29 AM): I wanted to suggest..if you could use mobius strip analgogy

akshay_mohan (2:08:42 AM): i don't think i recollect mobius strip

umakant_soni (2:08:59 AM): a Mobius strip only has one side and one edge

umakant_soni (2:09:07 AM): its shaped like infinity..

umakant_soni (2:09:24 AM): type in google...its a mathematic concept too..

akshay_mohan (2:09:36 AM): yayyy google

umakant_soni (2:10:43 AM): The Möbius strip has only got one side. If you draw a line down the middle of the strip until you get back to your starting point, you will find that you draw on both sides of the paper. The twist in the paper makes you change sides as you draw around. The Möbius strip has only got one side. If you draw a line down the middle of the strip until you get back to your starting point, you will find that you draw on both sides of the paper. The twist in the paper makes you change sides as you draw around.

akshay_mohan (2:11:16 AM): ahhh.. yeha i remember now, i played with it

akshay_mohan (2:11:28 AM): i started thinking of cominc strips earlier like moby dick !!!

umakant_soni (2:11:41 AM): cool...well so...there is no begining and there is no end

umakant_soni (2:11:59 AM): hope u didnt thinking more naughty

akshay_mohan (2:12:43 AM): you never know

akshay_mohan (2:13:05 AM): can't think of the the three names for the triology

akshay_mohan (2:20:04 AM): oh btw i am looking for to put in my thesis.. if you have interesting quotes you are welcome to contribute

akshay_mohan (2:24:32 AM): okee i have sent you an approximate draft of the TOC (the maximum I could do with the present condition of my neurons

akshay_mohan (2:24:55 AM): actually i would also like to include another scene from the Vedas if possible

umakant_soni (2:36:08 AM): seems good..

umakant_soni (2:36:24 AM): let me reflect..on it..I will mail u the my suggestions

umakant_soni (2:36:35 AM): bye ...going for lunch now

akshay_mohan (2:36:53 AM): it would be good if you can detail the headings based on what you think specfically where should case studies from the real world come in and how should i resent my two explorations

akshay_mohan (2:36:57 AM): bye =

akshay_mohan (2:37:06 AM): i will probably be here when you come back

akshay_mohan (4:04:10 AM): welcome back

akshay_mohan (4:04:24 AM): \

umakant_soni (4:11:33 AM): hi ...I am mailing u my suggestions

akshay_mohan (4:14:31 AM): cool.. i just got them...

akshay_mohan (4:14:40 AM):

akshay_mohan (4:16:28 AM): two comments:

umakant_soni (4:16:56 AM): yup..

akshay_mohan (4:17:24 AM): when you say in the conclusion of the case studies about the experiment showed chages in economic, social etc...due ot the device. There are changes only along the technology vector

akshay_mohan (4:18:07 AM): questions + comment 2: what do you mean when you say value creation by the sociological impact at the end of the thesis??

umakant_soni (4:18:25 AM): because thats what you measured...you didnt measure the social changes and economic changes...

umakant_soni (4:19:23 AM): you measured only the technological changes...because as an engineer we are taught to do and focus on that aspect alone..

akshay_mohan (4:20:27 AM): what do you mean by value creation by the sociological vector?

akshay_mohan (4:36:18 AM): what do you mean by value creation by the sociological vector? and also what is the justification of having these three specific vectors?

umakant_soni (4:36:44 AM): creation of social bonds...

akshay_mohan (4:36:57 AM): ok gotcha social capital

umakant_soni (4:37:07 AM): like every bond is stronger if the energy invested in it stronger..and thus a much larger force is required to break it..

umakant_soni (4:37:43 AM): yah..

akshay_mohan (4:38:00 AM): also when you were saying regarding Prahlad's case study: guess it might help you to work out all aspects of economics...of such a system..and where all the value will be getting created that will be making such a system viable? what did you mean?

akshay_mohan (4:38:17 AM): use his example and extned it or give my own example and use his economic model

umakant_soni (4:39:32 AM): give your own examples and use hi model to analyse it...and then you can give credit that you are using prahlad's model to see how much of the value gets created...

akshay_mohan (4:40:24 AM): ok

akshay_mohan (4:53:46 AM): ok i am off to sleep..

umakant_soni (5:05:18 AM): bye and sleep welll

akshay_mohan (5:05:52 AM): thanks ...

also...it would be nice to give a detailed profile of the test group..

umakant_soni (2:30:00 AM): like their age, behaviour pattern and what they liked...how they used technology...and sum it up in table format..

Evaluation in Cognitive Domain

The evaluation of the interaction between the participant and the Health-Zero orb is presented based on the three aspects: the skill set required by the participants , system usability and the usefulness of the orb in data visualization of the blood glucose levels.

The first aspect relates to the fact that an individual needs to have a specific skill set to operate a device efficiently. This depends on the technical nature of the device, the user instructions, the intuitiveness of the interface etc. This was measured through the interaction between the participants and the researcher and if they reported any difficulty in understanding the use of the device or its installation procedure.

The second aspect relates to the ability of the device to respond to the individual . Taken from the perspective of the health technology, it can be described as the ‘skill set’ required by the device. This includes factors like system robustness, * etc. This was measured through the device usage questionnaires and interaction between the participants and the researcher during the installation and the use of the Health-Zero orb.

The third aspect relates to the effectiveness of the device in serving its function. Here the Health-Zero orb was designed to reduce data complexity and help in interpretation of the blood glucose levels. This was measured through the subjective responses of the participants during the personal interview between the participant and the researcher.

The evaluation of the experience of the participants while using the Health-Zero orb is presented as an overall experience and then specifically in three different domains: affective, cognitive and interpersonal. The spiritual domain is not presented as part of the evaluation as it is beyond the scope of the thesis. The exploration has its implications on the moral domain that is discussed later in the discussion. In the next few, the evaluation of the system is described in the three domains of observation and is based on two modes of observation:

Individual Objective: This is through the results of the instruments that used a likert-type scaled items

Individual Subjective: This is through the personal experiences of the participants as narrated by them during the personal interactions with the researcher and through some of the subjective questions asked in the instruments.

A possible approach to the design of technology can be as follows:

based on Prahalad’s Future of the Competition []:

Dialogue:

Assessment

Risk Assessment

Transparency

Thus the process of design of such a technology design would mean converge of the individual with the people associated with the technology to have an interaction that leaves both the individual and the company in a state that is perceived better by both of them as being better than their earlier state. The process would involve:

Understand/Interact/identify/dialogue/engagement/recognize a need

- One needs to identify the state of the individual and determine the associated transformation required. Well being for an individual is a personal definition and it could be associated with a completely different state as compared to another individual and also a completely different state if the individual is at a different time period and location. Similar if there is a state of disease its completely diffenre tfor different people.

- Identify the limits of the technology. I would like to always happy without any repurcisions but its difficult for technology to create such a need

- Create a dialogue between the individual and the healthcare provider about a problem that would interested both the individual and the healthcare rpovider and can be addressed by the healhtcar provider

- For the individual to ineract with the healthcare provider, himself requires the ineraction to be at different levels with a basoc understanding of the idividual

Experience the need

- the need has a strong component of subjective understating that can only be provided either by the individual or by the experience itself.

Specify

- the blueprint of the possible solution. For a technological solutiuon it would be its system specifications, its functional specifications.

- This specifcation itself is important and acts in an interative process

- Based on the specifications, ineractiw the individual about the possible solutution.

Expect

- Make the individual a participant in the production process itself as a person to whom things are visible as much as possible. He needs to understand the limitations of technology. For example: people sometimes use technology and expect it to do something but many times it is not possible., it is important from the start to have the expectations right. Creating a sense of ownership improves the chances of the acceptability of the solution and also responsibility it things go wrong.

Inform

Inform the individual of the possible outcomes of the technology to the extent possible. It is important in healthcare for people to understand the outcome of a decision.

Evaluate the technology to see if meets the requirements

Adapt. Allow the crtierias to change as the system evolves.

Focus on your state of technology and analyze it.

Assess the state of the individual. Identify the factor that are important in the determinant of the individual’s health.

Another possible process sequence:

Understand the individual

Understand the technology

Experience the need

Experience the solution

Understand the individual

Evolve the Solution

|900 letters mailed to |Advertisement at the Joslin|Recruitment Table at the |Personal Referrals |

|potential participants |Diabetes Center through |Joslin Diabetes Center | |

| |brochures and posters | | |

|8 respondents |3 respondents |6 respondents and |1 respondent |

| | |inquiries (not kept | |

| | |count) | |

| | | | |

|4 participate in the study|2 participate in the study |6 participate in the |1 participate in the |

|(2 ineligible and 2 |(1 decides and 2 decided |study |study |

|decided not to |not to participate) | | |

|participate) | | | |

| | | | |

|Total 12 participants |

|6 participants only use the personal Health-Zero orb |6 participants provide a second Health-Zero orb to |

| |a friend or family member |

| | |

|5 complete the |1 had installation problems|3 complete the |3 had installation |

|intervention | |intervention |problems |

| | | | |

| | | | |

|5 complete the second |1 does not complete the |3 complete the second |3 do not complete the |

|visit |second visit |visit |second visit |

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