2.4 Health

Computer accessibility for disabled users

Computer accessibility for disabled users is fundamentally tied to the equality of access social / ethical issue. The Disability and Access section of BBC Bitesize is a good introduction to this topic, covering appropriate input and output devices. Both Microsoft and Apple have sections on their web sites that detail the accessibility features in their hardware and software.

Speech recognition is a common technology for physically disabled users - HowStuffWorks explains the technology behind it. Recently an Indian teenager created a device to convert breath into speech, desired for users with severe speech difficulties.

BrowseAloud is acessibility software for children with dyslexia and other learning disabilities. It includes functions to make text reading easier, including text to speech and colour highlighting.

Speaks4Me is a system to help autistic children communicate. Invented by a father who could find no useful system for his autistic son, the software runs on mobile devices and has a touch interface.

Another development currently being worked on is the ability to control a computer use brainwaves. Computer That Reacts To Thought A Lifeline For Brain Injured (Science Daily) and Voice recognition software reads your brain waves (New Scientist) are a good introduction to this topic.

This BBC news article and video shows a Cambridge lab where they test how elderly people use technology - the results are startling and highlight that a digital divide can occur in many situations.

Finally, The Madtoe Strikes Again: Hands-free Graphic Design is an inspiring story of a young man who, despite having limited motor control, creates graphic designs. The page details the variety of hardware and software systems he uses to create his work.

The Education page contains details of hardware and software specifically designed for people with special educational needs.

Lesson resources: Oobunta Case Study

In 2010 the case study for the ITGS paper 3 exam was "Healthcare in an East African country". Although the case study is changed every year, I still use this particular case study to teach the Health unit, since it really encourages students to think and apply the knowledge they have acquired through the two years. I like to teach this late in the course, when students should be beginning to revise basic concepts such as hardware, software, and networking for their mock exams, and starting to become proficient in applying the ITGS social and ethical issues. Below are a series of lessons I use to teach this case study.

• Healthcare in an East African Country (link to IB website, login required)
• Introduction slides - used to give some background information on East Africa and generate discussion about how Oobunta might look.
• Comprehension questions - I've found these useful for some students, as they encourage thorough reading and often reveal language related issues which might be initially apparent.
• Newspaper task - Another background task. Used to improve student understanding of the case study and the potential problems. This could easily be adapted to become a DTP practical lesson too.
• Issues review - a quick review of some of the issues students should have covered in the newspaper task.
• Texts Tackle HIV in South Africa - A very relevant article which can be used to start a class discussion.
• IT in healthcare (rubric) - Pair or small group research task for main IT and health technologies.
• Training methods - worksheet covering ways of training users of IT systems. Useful when considering Oobunta.
• Oobunta proposal task, rubric - The main task. Applies all of the content learnt in the previous activities to Oobunta. I have also done this task with students creating a video proposal, but found a written proposal better for making efficient use of time and covering content in the appropriate level of detail. To extend the task, use the cost spreadsheet below.
• Cost spreadsheet - to really challenge students, use this cost spreadsheet in conjunction with the proposal task above, and have them base their decisions on the relative costs of each item. I usually find they rise to this challenge quite well, even if some of the costs are a bit unrealistic.

Disease mapping and tracking

Information technology and modern communication networks are powerful and convenient tools for tracking disease outbreaks in near real-time. HealthMap.org offers an up-to-date online map of disease outbreaks across the globe. Flu.gov provides similar functionality for cases of the flu in the US, while Google Flu Trends does a similar thing, but using very different techniques (it measures search frequency).

Elsewhere, smartphones have been used to collect data on malaria cases in remote Uganda (Computer World), and have helped track Dengue Fever in India (Technology Review).

Activity tracking devices

A wide range of devices are capable of monitoring users' vital data. This is a sector where technology is changing rapidly. A simple Amazon search for activity trackers reveals a huge range of available devices, from high end devices like the Garmin Vivosmart, through general purpose trackers like the FitBit Charge 2, to more budget options such as the Misfit Ray.

• A Patch that Monitors the Body
• The hi-tech way to get fit (BBC)
• Wareable.com has reviews of some of the last health monitoring devices.

Product home pages are a good resource for learning about the technological features that are available today. Apple Watch, FitBit, and Misfit pages all contain a wealth of information.

The US military are even developing a 'smart tattoo' to monitor troops' vital signs constantly and unobtrusively.

Remote patient monitoring

Project Gerhome

Project Gerhome is the smart home / patient monitoring project I cover in the textbook. Its aims are to use a variety of technologies, including video cameras, to monitor elderly people in their homes. The site is primarily in French but there is an English-language page about the project here.

This page explains how multiple sensors are used to detect people in an apartment and even recognise different modes. For example, the experiments tried to detect people preparing a meal, eating, and fainting. The site includes some great images of how this might be achieved.

Remote monitoring articles

Could telehealth revolutionise NHS patient care? (BBC) and How tech can help the elderly stay independent (BBC Click video) discuss the potential benefits of these technologies. This BBC video explains how Alzheimer's patients can be tracked with satellite technology.

However, the New England Journal of Medicine performed research which suggested telemonitoring of heart patients produced no difference in outcome compared to in-patients. The article is a bit dense but includes some useful statistics.

Remote patient monitoring is a topic which is closely related to the smart homes topic in the Home and Leisure chapter.

Online health advice

Examples of online health advice created by official or professional groups include NHS Direct (advice from the UK's National Health Service), NetDoctor, and WebMD.

Online advice is naturally accompanied by concerns regarding the authenticity of the creators and the reliability of the information itself:

• A Cure For AIDS? A good example of why we should be wary with online health advice.
• Warning over 'untrustworthy' sex health websites (BBC)
• Internet child health advice 'wrong' (BBC)
• Warning over untested web 'cures' (BBC)
• Men warned over counterfeit drugs (BBC)

Medical research

IT & Health: Scientists Identify Drugs' Side Effects by Analyzing Search Data Collected From Millions of Users (The Atlantic) explores an innovate method of obtaining details about the side effects of drugs.

IT for health awareness and advice

The ubiquity of cell phone technology has seen it being used to provide health advice and awareness, particularly through text messaging. These systems have been credited with doubling young smokers' quit rates (New Scientist), and have been used to help tackle HIV in South Africa (BBC), encourage condom use in New York (NYTimes), and drive health IT innovation in several developing countries.

Telemedicine and Telehealth

Telemedicine can take many forms. Traditional hospitals can perform  consultations with patients in remote hospitals or at home: 

• Could telehealth revolutionise NHS patient care? (BBC video)
• With Telemedicine as Bridge, No Hospital Is an Island (NYTimes)
• Kenya: Aga Khan Hospital Set for First Video Link Surgery
• The online doctor will see you now (New Scientist)
• Take two Prozac and e-mail me in the morning (NYTimes)
• Smart phone technology acceptable for remote stroke diagnosis (Kurzweil AI) Article and video

Texting the Teenage Patient (NY Times) and Teenagers to take embarrassing ailments to Second Life doctors (Guardian) describe one particular scenario where telemedicine may have a significant advantage over face-to-face consultations.

However, research has also cast doubt on the cost-effectiveness of telehealth (Computer Weekly), while some doctors are wary about online house calls (The Age).

Patient simulators and training tools

Patient simulators are computerised mannequins used to train medical staff. Unlike traditional first aid mannequins, patient simulators use computer technology to provide outputs (such as 'heart beats') and realistic responses to treatment. Patient simulators are available in several versions, including male, female, child, and baby.

The CAE Healthcare home page has extensive information about patient simulators, including high quality images, video examples and use cases for nurses, EMS, and the military. Robot patients help doctors polish their skills (BBC video) also shows these patient simulators in use.

Virtual patients: hi-tech training for the operating theatre explains how Anatomage, a new touch-screen virtual operating table, works. The system features a complete digital 'patient', and is being used to train staff at Saint Mary's hospital in London.

Computer models for health care

Various computer models are used to help design new drugs and administer existing drugs and treatments more effectively:

• Predicting adverse drug reactions with higher confidence
• Design Help for Drug Cocktails for HIV Patients: Mathematical Model Helps Design Efficient Multi-Drug Therapies (Science Daily)
• Computer Model Could Help Tailor Chemotherapy Treatments (Science Daily)
• Computer Model for Testing Heart-Disease Drugs (ScienceDaily)
• Computer Model Against Unnecessary Use Of Antibiotics (ScienceDaily)

Other health models are used to improve our understanding of the human body:

• A Computational Model of the Human Heart
• Heartworks 3D Virtual Heart (MedGadget)
• Researchers use computer model to probe mysteries of human immune system (Virginia Tech)

Finally, computer models may be used to predict the spread of a certain virus or bacteria, with a view to preventing it:

• AIDS spread model (interactive model)
• Computers to help superbug fight (BBC)
• Computer model reveals deadly route of Ebola outbreak
• How modelers took on the Ebola outbreak (IEEE Spectrum)
• Measles epidemic simulator (interactive model)
• Computer models to predict the spread of Zika

Electronic Medical Records (EMR) & Electronic Health Records (EHR)

Electronic medical records resources:

• Two resources from the New York Times, Digital Health Records: The Hard Road Ahead and The Ups and Downs of Electronic Medical Records, provide an excellent and very detailed insight into EMR, their benefits, and their potential problems.
• Hospital puts medical records snapshot on smart cards (Network World)
• Learn about e-prescriptions
• Maui Family Doctor Achieves High Efficiencies With EMR Good example of EMR in a small clinic (video)
• Microsoft's HealthVault Example online EMR.
• Hunt wants paperless NHS by 2018 given the NHS' infamous history with IT projects, perhaps this article could also go in the IT Systems and Organisations page under 'project failures'.
• It is patently obvious the NHS must have online patient records (Computer Weekly)

Diagnostic and Therapeutic Tools in Healthcare

The following articles address the general topic of information technology in healthcare and its issues and impacts:

• Redefining Medicine With Apps and iPads (NY Times) explains how doctors can use a wide range of technology to improve the care they provide in their day to day work.
• The Digital Hospital (BusinessWeek)
• "Plug and Play" Hospitals (Technology Review)
• Better hospital IT 'would save thousands of lives' (BBC)
• Researchers say AI prescribes better treatment than doctors discusses the increasing use of 'big data' and artificial intelligence systems such as dynamic decision networks to improve healthcare and reduce costs. The article includes many links to other examples of developments in healthcare technology.

Robotic Surgery

The Da Vinci Surgical System is the most famous robotic tool to assist surgeons. HowStuffWorks is essential reading to understand the technology behind it.

Positive impacts

Perhaps unsurprisingly, many health care providers tout the benefits of robotic surgery. UC Health outlines these benefits, as does The Heart Hospital.

Negative impacts

Not everyone agrees that the impacts of such systems are positive, however. Robots Taking Record Number of Human Uteri (The Atlantic) charts the dramatic rise in robot-assisted operations, while Are Surgical Robots Worth It? (MIT) investigates some of the potential negative impacts that have been reported. Would you have robotic surgery? addresses similar issues. Cancer Patients Are Getting Robotic Surgery. There�s No Evidence It�s Better references an FDA study that found no overall benefits from robotic surgery, and found possible evidence of harm.

Training is an element of any IT system, but its importance can sometimes be forgotten. Salesmen in the Surgical suite (NY Times) is a tragic story of a patient whose operation was botched by a doctor with no previous experience on the Da Vinci Surgical System - a stark reminder that training is essential whenever new technologies are introduced.

Computer-controlled prosthetic devices

Computer-controlled prosthetic devices have made huge leaps in recent years, with lighter weight devices that can be controlled by the user's feet, electrical impulses from nerve endings, and even the mind.

Perhaps the most famous development is the "Luke Arm", created by Dean Kamen for DARPA.  (This video from 60 Minutes and this Technology Review article give a good sense of the wonder of this device).

There have also been developments in robotic legs for amputees and stroke patients (BBC) and more recently, the FDA even approved a computerised eye implant that can partially restore sight to blind people.

Learning to Accept, and Master, a $110,000 Mechanical Arm (NY Times) gives a detailed insight into what it is like learning to live with a 'robotic' arm.

Physical considerations: Ergonomics and RSI

Why is sitting in a chair for long periods bad for your back? (HowStuffWorks) and Mobile working propels RSI to "record high" (PCPro) both explain some of the health impacts and injuries that can be caused by poor ergnomics. Evidence on RSI 'urgently needed' (BBC) has statistics that reveal the extent of the impacts.

Call to protect workers from RSI (BBC) has some advice about preventing overuse injuries. A relatively new idea is standing desks, which some people claim are more ergonomic than sitting desks and can reduce health impacts.

Psychological considerations: Internet and game addiction

Computer gaming addiction raises many potential negative health, psychological, and economic impacts. The problem has become so bad in some countries that extreme measures have been taken to try to combat the issue:

• Internet addiction driving South Koreans into realms of fantasy (The Guardian)
• South Korea Expands Aid for Internet Addiction (NYTimes)
• South Korea Cracks Down on Gaming Addiction (TIME)
• Video: Addicted video gamer used drugs to stay awake and play
• Gaming addiction classified as disorder by WHO
• Gaming app rations child access to hour per day

Psychological considerations

The Child, the Tablet and the Developing Mind (NY Times) examines the psychological impacts on children of constant exposure to technology.

Teenagers 'checking mobile phones in night' discusses the effects of disturbed sleep caused by mobile devices.

Lesson Resources: The Future of Healthcare Technology

This large poster by envisioningtech.com (CC-BY-SA) highlights some of the ways technology may change healthcare in the future.

It is a good introduction to the health topic as it covers many technologies that are on the cutting edge of healthcare: from diagnosis and treatment methods which are in use today to futuristic technologies such as biological implants, augmentations, and 3D printing of medicines.

Lesson Resources: Revision Flashcards

Health revision flashcards to test students on the key terms. The 'Learn' and 'Test' modes of Quizlet work best.

3D Printing and Healthcare

Hospitals are now using 3D printing technology to turn medical scans into 3D models to plan surgeries and other treatment. 3D Systems is one such company - their web page contains a wealth of information about the technologies and techniques they employ. Another good example is Simbionix, whose site has examples of 3D printing heart models, and videos of the process.

Two good case studies are Mina Khan, who had her life saved by a 3D printed heart,and a young baby called Kaiba had his life saved by doctors using a 3D printed component to help him breathe properly.

4D animated scans of unborn babies have been around for a while now; companies such as 3D babies now offer the chance to turn these scans into 3D models.

Some researchers are also investigating how 3D printing can be used in prosthetics, particularly with a view to improving facial prostheses. How 3-D-Printed Prosthetic Hands Are Changing These Kids Lives is a video well worth watching.

The Benefits of 3D Printing Healthcare is an article from Betanews which does a good job of explaining these technologies and how they might develop in the future.

Examples of FOSS in Use

ITGS students sometimes mistakenly believe FOSS is 'trial' or 'simple' software, or that it lacks features compared to commercial software. The examples below highlight where FOSS in used in the 'real world' and where the advantages and challenges are found, and should help ITGS students understand that very large organisations do make extensive use of free and open source software. 50 places running Linux is a good place to start, with some perhaps unexpected examples.

FOSS in schools

• Open source question for schools (BBC) asks whether schools can make significant budget savings by going open source.
• Penn Manor High School and Westcliff High School are two good FOSS-in-schools case studies.

FOSS in government

• Met Office says open source is 'backbone of our operations' (Computer Weekly)
• Home Office saves £10m by opting for open source (Computer Weekly)
• FOSS in governments addresses the use of open source software in various countries, including the UK, Germany, and Italy. There are also some ITGS lesson ideas at the end of the article.
• Open source software: how it saves governments money discusses ways money can be saved beyond simple "it costs less to buy" arguments.

FOSS in Healthcare

• NHS to embrace open source explains the benefits the UK's National Health Service hopes to derive from switching to open solutions.

All Your Devices Can Be Hacked

All Your Devices can be Hacked discusses the increased security threats as much and more devices feature Internet connectivity - including implanted medical devices, car networks, police radios, and voting machines. The very interesting - and worrying - aspect of this video is that it is not mere scaremongering - all of the attacks described, including disabling a pacemaker and taking over control of a car, have all been successfully executed as proofs of concepts. This makes great discussion material for ITGS students in several different strands of the ITGS triangle.

Activity tracker apps

In addition to dedicated devices, the sensors in many modern smartphones allow activity data to be tracked:

• PC Magazine has reviews of the best apps in this category.
• Digital Trends has another good list.

• Tracking Lung Health With a Cell Phone
• A Medical Lab in your Smartphone

Remote patient monitoring

Health monitoring isn't only done for "leisure" purposes by joggers, cyclists, and other interested users. Increasing doctors are using technology to monitor their patients remotely, freeing hospital beds and hopefully helping detect signs of problems early. The following articles and examples may be helpful:

Remote Patient Monitoring Lets Doctors Spot Trouble Early (WSJ) explains how more advanced tracking technologies are being used to monitor patients with chronic conditions such as extremely high blood pressure or cardiac problems.

The virtual doctor visit (Washington Post) is another good example of how conditions like diabetes can be managed in this way. PBS Newshour also reports on this issue.

The Telegraph reports that the British NHS plans for patients to be remotely monitored in a 'digital revolution' of the service.

Examples: Social assistance robots

With ageing populations many countries are looking for new ways to care for the elderly. Carer robots or social assistance robots (SARs) are a particularly challenging type of robot to develop. Not only must they be able to cope with a wider range of tasks and situations than industrial robots, but they must present a friendly and interactive interface to the user. Many of these challenges are very similar to the toys being developed in the 2018 ITGS case study. Below are some examples and resources for the latest in care robots:

• Robots could help solve social care crisis (BBC).
• How a robot could be grandma�s new carer
• A robot is my friend: Can machines care for elderly?
• Undiscovered Japan: Using robots to care for the elderly (video)
• Is robotics a solution to the growing needs of the elderly?
• A robotic revolution in healthcare
• Robot carers for elderly people are another way of dying even more miserably