Monday, March 13, 2006

Health Care and Self Care

Spring is coming. No, though the first blossoms are visible in the garden, it is not that kind of spring. It is also not the Spring Framework. It is the OSGi spring! Last week I talked to many different people and it keeps surprising me how many companies tell that they have been using OSGi for years or intend to start using it in the next project. It is like green buds appearing between the last remains of winter. There is such an increasing awareness that connected devices change the playing field; The OSGi specifications together with Java are a core part of the puzzle.

A key example of this spring was shown in a report about a large health care project. The aging of the western populations has a potentially devastating effect on the health care systems in Europe and the US. Older people (after ~ 65) need exponentially more care while at the same time the labor force is decreasing. If nothing is done, hospitals will be overwhelmed in the next two decades, therefore, the problem is urgent. We need to develop solutions that will allow the health care workers to spend their time on what only nurses and doctors can do while taking other tasks of their hands.

Automation can clearly supply parts of a solution, if applied with care. There are obvious efficiencies to be gained by further applying automation in, and between, health care institutions. However, the use of these solutions has been ongoing process. It is not likely that the required efficiency improvements (my estimate is at least a magnitude) can be achieved through administrative means.

The only solution seems to be to engage the patient: self care. Obviously this simple solution is not that simple otherwise it would already have been applied successfully on a world scale. A key problem that is hard to solve is the monitoring. A hospital monitors the patient for complications and can immediately take appropriate actions when needed. The huge challenge is to provide the means for self care as well as providing the monitoring infrastructure and inevitable emergency help.

This is a very complicated problem with an unpleasant number of aspects that can be categorized as fundamental. Solutions must be extremely reliable otherwise people will die or suffer; this kind of reliability is far away from current consumer electronics (and moving in the wrong direction). The usability of the solutions must be flawless because the users will be older people with reduced eyesight, handicaps, stiff muscles, reduced brain capacity and all those other burdens that age and sickness will put on all of us. Configuring solutions must be automated and trivial or we will have to exchange nurses for technicians. And last but not least, privacy must be maintained while at the same time allowing nurses and doctors access to the information they need.

Looking at the dramatic figures it is quite clear to me that there is no choice but to develop the technology that will enable self care on a large scale, and we better hurry. It also seems clear that domotica can play an important role. Sensors to monitor the patient and devices that can help administer the medications will require local support in the home to help providing the required reliability (e.g. network failures) as well as reduce the load on the central servers by reporting only exceptions to reduce the central load. However, also mobile phones could provide an important role so that the patient can lead an active life.

The biggest technical challenge of all will be software (and I can assure you that just the social challenge will be huge). Sensors, actuators, servers, analysis, monitoring, and managing largely consists of connected software components. We must realize that much of the required functionality is beyond the state of the art today. It is therefore paramount to develop an infrastructure that provides an even playing field for anybody that can contribute to a solution. Trying to create “the” solution is planning for failure.

The OSGi specifications provide a unique building stone for such an infrastructure. No other software technology provides so many of the crucial infrastructure aspects that are needed to implement large scale self care. The portability, security, reliability, integrity, and manageability are all prerequisites for a health care infrastructure. The tremendous challenge of large scale self care is an opportunity for the OSGi Alliance. It actually is surprising that no companies have flocked around this area and created a Self Care Expert Group. Let’s face it, what is the alternative?

Peter Kriens
OSGi Evangelist

P.S. Next week I will be at EclipseCon, hope to see you there!

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