Objectives:

This workshop brought together needed interdisciplinary expertise, assess the state of the science at the human, medical, and technology levels, and articulate a research vision for a systems engineering approach to the development of technologies and solutions to support the home management of persons with significant chronic diseases and their family care providers. Effective home management of such chronic diseases as dementia, heart failure, hypertension, chronic obstructive airway disease (COPD), and asthma would reduce hospitalizations and other healthcare costs and improve quality of life. Currently, there is a paucity of research in these aging in place technologies (AiPT) from a systems approach that includes the expertise of both health and computer science. This workshop discussed challenges and opportunities and provide a research agenda regarding the next steps needed in the development and application of technology to home management of chronic diseases.

Needs and Justifications:

An understanding of the current status and future directions for AiPTs for aging, community living and independence is needed in order to examine critical gaps in knowledge, standards, and infrastructure supports. This workshop was needed to identify key research questions, measurement challenges, and strategies including scale-up evaluations and deployment or technology transfer.

• One important challenge in this field is the creation and validation of algorithms that rely on sensed data for home healthcare uses. Technologies used in home-based healthcare might include continuous, real-time, non-invasive monitors for health status, medical conditions, and disability. Current deficits in automated analysis of the data include identifying individualized care patterns driven by long-term longitudinal data, iterative validation of data (for inclusion in electronic medical records), and methods for integrating physiological, behavioral and psychological data. In particular, remotely sensed data requires authentication of data that is inherently unsupervised and potentially will require innovation for validation and comparison to current “gold” standards based on acute care settings.
• While many medical related sensing and actuation technologies have been developed, there are still significant barriers to widespread use. Research challenges include having these smart home systems deal with the logistics of deployments for elderly, sick, non-expert users over long time periods, and having these systems  evolve as a patient’s medical problems change. Maintenance of the systems and continuous validation that the systems are operating correctly are also challenges. The level of accuracy required for the sensing and actuation systems are generally unknown.
• Along with novel sensing and measurement technologies, we can imagine information technology tools for integrating data from multiple sources, creating meaningful presentations and visualizations of information, and for integrating information into a person’s health record.  Current deficits in information presentation tools include the visualization of passive and activity monitoring of daily activity as well as tools that mediate communication and information sharing among healthcare providers, patients and caregivers.  All of this is coupled with a need for systems that can interact and respond for just-in-time interventions when needed. This problem space requires more advanced inquiry into such areas as the attitudes and beliefs of users, and the usability and utility of systems for the diverse stakeholders that may use these technologies.
• Additionally there is a need to explore methodologies for in-field evaluation and evolution of technology, addressing how one co-evolves technology and its evaluation in a medical context. In other computing domains, companies release software into the wild, observe how it’s used and evolve it quickly to address issues/opportunities that they discover. This process is counter to traditional NIH-style research.  Given the speed in which technology changes occur, a more agile process is needed.

The outcome of this activity was the preparation of a white paper describing a research agenda to inform new federal research on home health technologies for an aging population. that will lead to randomized trials to test the use of these technologies for extending the active and healthy living for seniors. This workshop focused on the use of technologies and systems for health care, services and monitoring provided in the home and community that targets disorders common to substantial proportions of the aging population and persons with chronic disabilities.

Organizing Committee:

Alice Borrelli
Director of Global Healthcare Policy, Intel

Sara Czaja
Professor, Psychiatry and Behavioral Sciences & Industrial Engineering, University of Miami

Jeff Kaye
Professor of Neurology and Biomedical Engineering, OHSU
Director of the Oregon Center for Aging and Technology (ORCATECH)

Dan Siewiorek
Buhl University Professor of ECE and Computer Science, CMU
Director, Quality of Life Technology Center (NSF ERC), CMU

John Stankovic
BP America Professor of CS and Co-Director of the Wireless Health Center
Professor, Computer Science, University of Virginia

Elizabeth Mynatt
Professor of Interactive Computing, Georgia Tech, CCC Liaison

Erin Iturriaga
National Institutes of Health, National Heart, Lung and Blood Institute

Wendy Nilsen
National Institutes of Health, Office of the Director

Ann Drobnis
Director, Computing Community Consortium