Essay: Using the Internet of Things within the Healthcare Industry

As the second essay is finished and received very well I also wanted to share this essay. This time it is about the emerging technology ‘Internet of Things’ and  the healthcare industry. As mentioned earlier, if you have any question or comment please feel free to leave a reply!

Introduction

The healthcare industry is in emerging need for change. As the Economist states in their vision on the future of healthcare trends, patients are very skeptical that the system can deliver the high-quality healthcare to all patients (Economist, 2011). The economist also states that patients also tends to take more responsibility for their own health. Using this trend more and more software applications are available. Not all of them offer a quality that is comparable with the already existing healthcare technologies, however the fact remains that applications are created using a community of developers outside the traditional firms that deliver hard- and software for the healthcare industry. As the new application become more and more familiar the question is now how are hospitals coping with this new trend, and on which kind of technology should hospitals have a focus? Most of these applications become available with new functionalities on devices, however the data that is used within these applications are powered through the Internet of Things. So the key questions are, what is the Internet of Things, and what should hospitals expect from it?

Internet of Things

In order to define the technology Internet of things it is good to have a look at the definition which is used. However a lot of definitions will be used for the internet of things. In 2010 a research group of the European Commission performed research to the Internet of things and when comparing all different kind of definitions, they came up with the following definition: “The Internet of Things is a dynamic global network infrastructure with self-configuring capabilities based on standard and interoperable communication protocols where physical and virtual “things” have identities, physical attributes, virtual personalities and use intelligent interfaces, and are seamlessly integrated into the information network” (Sundmaeker, Guillemin, Friess, & Woelffle, March 2010).

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Figure 1: Evolution from Electronic Data Interexchange to Internet of ThIngs

To put it into more simple words, within the internet of things all different kind of items, from socks to mobile phones, from cupboards to refrigerators everything can be connected to the internet. When all these kind of items uses the same kind of data formats , all of these devices will be able to connect to the internet, and thus creating an Internet of things.

The Internet of Things is not specially a new technology, however the Internet of Things is more an innovation because all kinds of existing technologies will be combined. As manufactures adds more and more new functionalities to the devices, all of these devices can become sensors for all sorts of problems. By creating (mobile) applications that uses these new functionalities more and better applications will be created by communities or manufacturers. For example Nike+ and Fitbit collect a lot of data when doing a running exercise, these companies are able to analyze the performance of the runner without any intervention.

In recent years the Internet of Things became more and more a popular buzz word. As the term was often used and the definitions of the term Internet of Things became clear, the technology was added by Gartner in their yearly hype cycle. Gartner creates a hype cycle in order to determine whether or not technologies are new or already commercially interesting. In the Gartner Hype cycle for emerging technologies 2012, the Internet of Things can be found for the first time (Gartner, 2012). Gartner reviewed the Internet of Things and stated that the Internet of Things is a technology trigger, which means that it is a fairly new technology where none too little products exists, however the stories and media will trigger significant publicity. Gartner also states that the Internet of things will be a common technology in more than 10 years (Gartner Hype Cycles, 2013).

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Figure 2: Gartner hype cycle for emerging technologies

Personal Healthcare / possibilities

As Inge Krogstad presents in her research, the Norwegian authorities have only one problem in healthcare for the coming decades, that is the need for more workers in the health- and care services. Krogstad states that Norway needs at least 100.000 extra workers within this business in order to care for all the people who needs this kind of service (Krogstad, 2012). The same problem arises for other west-European countries as The Netherlands, Germany, United Kingdom and also non-European countries as Japan and the Americas.

Krogstad states that the Internet of Things can help in resolving the issue that is described above. Krogstad states that the Internet Of things can help solving the issue as it enables more automatically clinical decision support and enables the patient with self-service and welfare technology (Krogstad, 2012). The most important part of the solution of Krogstad is the self-service bit. Within this context new applications will be available a lot in the coming years. The vision on the possibilities that the Internet of Things can bring for the self-service within healthcare changes at a very quick ratio. In 2005 Simonov et all created a discussion document in which they stated that there are possibilities to start a video conference with attached medical peripheral equipment, or home monitoring employing remote devices such as an Otoscope, Stethoscope and ECG to allow a remote physician to inspect inside a patient (Simonov, Zich, & Flavia, 2008).

However due to the changed technologies and the rise of the Internet of Things, specialized (and thus expensive tools) are no longer necessary. For example the Otoscope can be replaced by an iPhone with the application Remotescope (Georgia, 2012), an stethoscope can be replaced with an iPhone phone using the application iStethoscope (Guardian, 2010) an ECG can be created using technologies used by Nike+ and Garmin (Brandon, 2012). And this is only a short overview of three tools that are used a lot by physicians. New sensors are also being used more and more, Melanie Swan has created an overview of lots of sensors that are more and more feasible these days. For example nowadays stretchable electronic patches are available. These patches are able to monitor heart rate, brain activity, body temperature and blood pressure. After the measurements the patches sends their data wirelessly to devices which stores the measurements (Swan, 2012). Another example of new technologies which are being used to add new features are wristband sensors. These sensors, which looks like regular watches receives technologies to measure the type of exercise, allows single-button diet tracking, measures sleep and make personalized recommendation about changes a user can make to their life style in order to feel better (Swan, 2012). The last type of sensors that absolutely needs to be mentioned are the new available EEG’s. These devices are able to measure brain activity which can be used for example for sleep analysis (Swan, 2012). Examples of these new EEG devices are shown in Figure 3.

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Figure 3: examples of the first and second generation EEG devices

The remark that should be made for the above mentioned applications is that the data that is collected by the apps is served to the user. The user is able to do with the data whatever he likes, just storing the data within the application is a possibility and get some Business Intelligence out of the website that suppliers deliver with the application, or sharing the data through social networks as Facebook and Twitter. A famous example is the Nike+ sensor system which provides the user which these kinds of possibilities (McClusky, 2009). .However the most important users of the data, physicians, are not jet able to use the data or are not jet willing to use the data. As the Economist found in their research is that 49 percent of the questioned physicians are not seeing mHealth as an opportunity due to reimbursement structures, privacy and security issues and the lack of proven business models (Roney, 2012).

Personal opinion

In my personal opinion the usage of the combination of devices and applications that become available due to the Internet of Things and the possibilities they will add to our medical systems should be used and integrated a lot more within the medical systems of today. Using exchange and sharing of data from the applications the patients use, enables the physicians to gather more data that is accurate and valuable for the diagnosis of the health problem that is discussed. The more and accurate data can be found in the fact that familiar tools and surroundings can be used to monitor the patient. The usage of the tools already used by the patient enables gathering of data during a longer period of time, making sure that the data is consistent and not caused by coincidences.

The most important part is that hospitals, physicians and other employees in the health- and care industry sees the opportunities that the Internet of Things delivers and how these possibilities can contribute to the successful curing of the patients. The data must be received, stored and analyzed, therefore Hospitals should start discussing how the data that is gathered by applications, tools and sensors used by the patient should be integrated in a medical health record that is stored within the hospital.

As new technologies continue to enter the market new business models will become available as well. Based on a presentation given by TNO, there will be three different types of groups for new business models: Collecting and analyzing data, Communicate and interact, Automation and checks. Using the Internet of Things the primary business model that is already in place doesn’t have to be changed. Companies still needs to sell assets (like Nike and Philips) or services (Like FedEx and Tesco). However the services around these selling points can be quite different than we’ve seen in recent years. For example new apps can be sold, new target groups can be targeted and specialized data can be acquired and being shown to the user.

However certain challenges needs to be overcome, especially when looking to the healthcare industry security and privacy issues are one of the strongest challenges that still needs to be overcome. And when looking at privacy and security the most important challenge isn’t even mentioned. The most important challenge we face is the acknowledgement of these tools and the acknowledgement that these tools can deliver value to the healthcare or to the daily live (as these application might improve our live standards).

Conclusion

Within the Internet of Things all kinds of devices will be connected to the internet and thus connected to each other. Using these new technologies provides a lot more possibilities for already existing devices, and some devices that will be used in order measure certain aspects using sensors. Using these new techniques provides a lot of possibilities for new entrants in the markets.

References

Brandon, J. (2012, 02 01). We Test the "Internet of Things" with 3 Wireless Sensors. Retrieved from Popular Mechanics: http://www.popularmechanics.com/technology/gadgets/reviews/we-test-the-internet-of-things-with-3-new-wireless-sensors-ant-technology#slide-4

Economist, T. (2011). The Future of healthcare in Europe. The Economist Business Intelligence Unit.

Gartner. (2012, 08 16). Retrieved from Gartner Hype Cycle for Emerging Technologies: http://www.gartner.com/newsroom/id/2124315

Gartner Hype Cycles. (2013). Retrieved from Gartner: http://www.gartner.com/technology/research/methodologies/hype-cycle.jsp

Georgia, T. (2012, 09 12). iPhone Attachment Designed for At-Home Diagnoses of Ear Infections. Retrieved from News Room: http://gatech.edu/newsroom/release.html?nid=155181

Guardian. (2010, 08 10). iPhone set to replace the stethoscope. Retrieved from Technology News: http://www.guardian.co.uk/technology/2010/aug/30/iphone-replace-stethoscope

Krogstad, I. (2012, 02 01). Internet of Things for Healthcare Applications. Retrieved from Internet-of-Things.no: http://www.internet-of-things.no/Presentasjoner_01_februar_2012/Inge_Krogstad_SAS_Institute_Workshop_IoT_Oslo_01_February_2012%20.pdf

McClusky, M. (2009, 06 22). The Nike Experiment: How the Shoe Giant Unleashed the Power of Personal Metrics. Retrieved from Wired.com: http://www.wired.com/medtech/health/magazine/17-07/lbnp_nike?currentPage=all

medGadget. (2012, 09 20). Remotoscope, an iPhone Otoscope Inching Closer towards Commercialization (video). Retrieved from Medicine / Pathology / Pediatrics: http://www.medgadget.com/2012/09/iphone-otoscope-inching-closer-towards-commercialization.html

Roney, K. (2012, 07 20). Mobile Health: Why Physicians, Hospitals Should Overcome Reluctance. Retrieved from Becker’s Hospital Review: http://www.beckershospitalreview.com/healthcare-information-technology/mobile-health-why-physicians-hospitals-should-overcome-reluctance.html

Simonov, M., Zich, R., & Flavia, M. (2008). Personalized Healthcare Communication in Internet of Things. Proc. of URSI GA08.

Sundmaeker, H., Guillemin, P., Friess, P., & Woelffle, S. (March 2010). Vision and Challenges for realising the Internet of Things. Brussel: Cluster of European Research Projects on the Internet of Things.

Swan, M. (2012). Sensor Mania! The Internet of Things, Wereable Computing, Objective Metrics, and the Quantified Self 2.0. JOurnal of Sensor and Actuator Networks, 218-253.

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Essay: Using Extreme Programming and SCRUM during the development of web and mobile applications

During the lecture I currently enrolled with (Next Generation Business Applications), we have to write some essay’s. As these might be interesting, or might even start a discussion I will post these to my blog as well. If you have any question or comments please feel free to leave a reply. The essay which is stated below is the first out of three essay’s we have to write. This first essay has to deal with topics as “Why SCRUM and XP are used creating mobile and web applications and which tools can be used during such projects.”

Introduction

Nowadays every organization can’t be without a website. Using the websites enables the business of entering a rapid growing market. The rapid growing market is no longer the market that is very close to the physical location of the business, but now involves the entire world. Besides websites, mobile applications are more and more important for businesses, new features are constantly added to these platforms. Adding new features often involves a project in which all the requirements are set and after collecting a lot of new features updates can be enrolled. However during these project new insights are gained constantly, planning issues arises every now and then as documentation made at the beginning of the project often misses important components. The here fore mentioned issues were found most of the times the waterfall methodology is being used. The waterfall methodology was used heavily during the beginning of 00’s. Nowadays agile methodologies as Extreme Programming (XP) and SCRUM are more and more finding its way to the software developers. But what exactly is XP, how can we compare it with SCRUM, and why is it especially used for web based systems and mobile applications?

Comparing XP and SCRUM

In general the Scrum methodology is very comparable with the XP methodology. Both methodologies work on an iteration basis, instead of a large waterfall methodology which delivers all of the required features at the end of the project. The set-up and the way the iterations are worked through is quite the same for both methodologies.

However when comparing SCRUM and XP some differences can be found. First of all the duration of the sprints can be quite different. Within Scrum a sprint normally takes one to four weeks, and within XP a Sprint will last no longer than two weeks. Second when planning these sprints changes can also be noticed. Within SCRUM the development team updates and reprioritizes the backlog every now and then. Within XP the planning will be done with both the business (in most cases the customer) and the team of developers. Within XP the business determines the scope, priority and the composition of the releases, where the developers determines the estimates of the work items, the consequences, the process and the detailed scheduling. Together they will find the most optimal solution for the task at hand. During the sprints changes can also be seen, for example changes can still be made due to changing business requirements within XP. However within SCRUM once the items are planned into the iteration, no changes can be made from outside the team. When necessary the team is able to add additional features because these are necessary during the iteration.

The last difference between XP and SCRUM is the prescription of the used practices. As Scrum doesn’t prescribe any engineering practices, within XP more than 4 of the practices are used to described engineering practices, for example: automated testing, pair programming, simple design and refactoring (Cohn, 2009).

Using XP and SCRUM

As mentioned earlier web based applications and mobile applications are more and more important for businesses. This also means that business invest more in the website. At any moment a decision can be made that the website or application needs to be replaced or needs extra/better functionality. In most of these cases functionalities needs to be added yesterday instead of thinking thoroughly about the requirements. When functionalities needs to be added to the website as soon as possible it can be useful to start a project with a group of programmers that are used to the XP or the SCRUM methodology.

Using SCRUM or XP means that not all requirements and all functionalities have to be thoroughly defined at the start of the project or even might change during the project. Using SCRUM or XP enables you with the possibility to deliver a working part of the product at the end of every iteration. With this product the customer gets more insight in the final solution and can make changes after each iteration, which are added to a new iteration. Doing this reduces the changes of unwanted functionality to a minimum. By using one of the core values of XP, by adding a business employee to the development team, new and innovative ideas can be created throughout the process. Using SCRUM or XP also means that the run-up phase can be very short as not all functionalities needs to be documented, however it is important to bring the documentation of the project up to date at the end of the iteration.

Using all these kinds of aspects it is relatively simple to set-up a team and plan all the various iterations that are required. Using small iterations the most important features can be added to the web based application within several weeks instead of several months when using the waterfall methodology. Besides these time saving actions the quality of the code will also be better as one of the practices of XP states that tests needs to be written first. Using this kind of methodology makes sure that additions in next iterations will be less problematic as lots of the code are tested automatically, and when tests are broken it is relatively easy to find the code that creates the problems.

In the previous paragraphs several notions of advantages of SCRUM and XP compared to the waterfall methodology are mentioned. However the most important advantage is the planning side of the SCRUM and XP. Within the waterfall methodology the planning is mostly dictated by the customer and the project manager. However within SCRUM and XP the development team in consultation with the customer is responsible for the planning. This provides much more responsibilities to the team and the individual who are responsible for giving a realistic time planning (Little, 2012).

Tooling XP and SCRUM

Throughout the world wide web a lot of tools can be found that supports the development team by their planning and developing the code. The software must be able to determine the product backlog where all the remaining work items for the product are placed. Besides the product backlog, a sprint backlog should also be possible as the team needs to be in control of the tasks that are defined for the sprint and how long the tasks will take. Tools which supports these kinds of tasks are: Assembla, codeBeamer, Microsoft Visual Studio, YouTrack etcetera. Each tool is unique in its kind and is able to support SCRUM and XP. However should be noticed that some of these tools needs to be configured first in order to maintain the very high standards often set by the methodology (SCRUM Development, 2013).

Conclusion

XP and SCRUM are very much the same, but differences can be found on several small details. Using SCRUM or XP speeds up the development of the various requirement and delivers the requested features faster and with more quality to the customer.

The question is now why should SCRUM or XP be used when developing a new kind of application? Well most of the arguments are already made. First of all the documentation is far from ready. As there will be new ideas for features throughout the project and the priority of these features can be different at any sprint, it should be wise to have flexible planning. Using XP also requires the team by applying several coding standards that will add flexibility to the project but also quality control and fun during the development.

References

Cohn, M. (2009, 02 20). MSDN blogs. Retrieved from MSDN: http://www.mountaingoatsoftware.com/blog/differences-between-scrum-and-extreme-programming

Little, J. (2012, 03 24). Waterfall versus Scrum: How do they compare? . Retrieved from Agile Consortium: http://agileconsortium.blogspot.nl/2012/03/waterfall-versus-scrum-how-do-they.html

SCRUM Development. (2013, 04 08). Retrieved from Wikipedia: http://en.wikipedia.org/wiki/Scrum_(development)#Project_management_tools_that_support_scrum