HealthOS: a middleware platform
Title:Â A Closed-Loop Approach for Improving the Wellness of Low-Income Elders at Home Using Game Consoles
Authors: Â Jong Hyun Lim, Andong Zhan, JeongGil Ko, Andreas Terzis, Sarah Szanton, and Laura Gitlin,
Affiliation: Â Johns Hopkins University, MD, USA
Presented/Published: Â IEEE Communications Magazine, Jan. 2012Â
Digital Object Identifier (DOI)::  10.1109/MCOM.2012.6122531
HealthOS, a middleware platform that sits on the cloud, is a new approach that aims to minimize the need for user-intervention by caregivers (i.e. nurses or family relatives), and improves self-management that yields more participation by unattended elderly (typically living at home and especially for those with low-income) in performing physical performance tests design to reduce the risk of falls and detect the chances of getting a heart attack. HealthOS is also a development platform. Â It allows integration of multiple healthcare monitoring devices (or fitness monitors) and facilitates easy access to the data for analysis, visualization, presentation, and integration with existing healthcare record systems.
Statement of the Research Problem:Â
The number of elders with complex chronic conditions is rising as the number of middle-aged adults reporting difficulty with physical function increases and as more elders with disabilities prefer to live at home; these factors combined are two of the major contributors to rising healthcare costs. Also, these two factors can lead to poor quality of life (especially for those with low income).
After developing a system that combines balance exercises (to prevent fall risk) with monitors that help assess the risk of heart-attacks, coupled with periodic nurse visits, and conducting a set of ’Short Physical Performance Battery of tests for the participants the results showed low participation (some only practiced when nurses visited their home). So, the key question is: ”how do we close the intervention loop so that we can minimize the caregivers’ workload, include family members, and increase the quality of care at the same time?”Â
Description of the Research Procedures:
Their stated aim is: ”to improve the process of various applications in the healthcare domain where user- interventions are necessary.” Their approach uses a gaming system (e.g. Nintendo Wii) with a physical exercise app designed to motivate, offer various levels of difficulty, have an UI suited for the elderly, offer voice interaction, and various ways of showing the progress or results. A tool to interact with caregivers, a network of similar patients, and family members is also a requirement so use of a smartphone is an important element in their proposed solution.
To combine the weight measures from the gaming system with data from heart rate monitors and see the correlation for detecting the chances of a heart-attack, for example, they have developed HealthOS. HealthOS is a middleware running on the cloud. It collects data from pervasive healthcare devices, inte- grates healthcare applications, and provides a development platform through RESTful APIs.
In a nutshell, HealthOS has four layers of function: 1) device drivers 2) a database layer, 3) a pipeline layer (data routing/packaging) 4) management, security (privacy), and mobility. At the edges of this system on one side are: the health monitoring devices, and at the other are data visualization, data presentation, and healthcare record repositories interfaces. They describe a simple and easy way to create drivers and pipelines, but only show an example where the Nintendo Wii is used. The description of encryption (for data access) doesn’t compare their approach to others nor wether it addresses HIPAA compliance, but they do cite an article that discusses Ciphertext-Policy Attribute based Encryption (shown to have been used in HIPAA compliance).
The article does not present how this tool or approach actual performs. There is no research that was actually carried out, thus no results are presented in the article.
There are no results from actual test subjects presented in this article.
Their hypothesis is never tested. They designed an innovative tool, but in this article it is not put into action. Looking at the first author’s website, there are two submitted articles for publication listed. Which might suggest that actual results and data analysis are presented.
A middleware platform that enables multi-device sensing sounds like a great ideaÂ
The authors briefly describe an easy and simple way to create drivers for new devices and pipelines for these
HealthOS employs encryption
Excellent mobile tool DailyAlert (Android app) that connects to a cloud and offers Google Cloud to Device Messaging. It is a mobile intervention system design to provide alert notifications to both patients and caregivers and to a patient’s support network.Â
The article does not present evidence on how falling or heart attacks contribute to rising healthcare costs
They don’t show or cite previous work showing that short physical perfor- mance exercises that contributes to better balance, reduces falls, or reduces the incidents of heart attacks
There is no evidence in the article on how their approach (HealthOS) minimizes the need for user-intervention by caregivers and improves self- management that yields more participation by unattended elderly in per- forming physical performance tests.
Designing something like this for elderly with low-income is too broad, in other words many elderly with low-income can be further classified into those that are 1) internet savvy, with access to gaming gear, able to afford a smartphone, 2) those on the other side of the digital divide, who would not be able to afford a smartphone nor gaming equipment simply because of factors like race, socioeconomic status, etc., and last, but not least, 3) elderly with complicated medical conditions (or not) often have or perceive barriers to caring for themselves that can be far more complicated than one can imagine.Â
The items listed in the Cons section are areas for improvement.
I visited the first-author's website an did notice that he has some papers out for publishing. Â I am looking forward to seeing how that work augments or complements this paper.
Darko Kirovski and Nuria Oliver and Mike Sinclair and Desney O. Tan, "Health-OS:  a position paper," International Conference on Mobile Systems, Applications, and Services," 2007, pp 76--78, doi: 10.1145/1248054.1248077
D. Estrin and I. Sim, “Open mHealth Architecture: An Engine for Health Care Innovation,” Science, vol. 330, no. 6005, Nov. 2010, pp. 759–60, doi: 10.1126/science.1196187
