The costs for healthcare in the Netherlands are growing faster than the GPD, while at the same time the Netherlands has an increasingly ageing population (see figures below).
It is desirable, from an economical and a social point of view, to provide automated care support to people in their own homes whenever possible, in order to encourage, support, and maintain activities and participation of elderly in their familiar social context. The U-Care project aims at developing solutions that facilitate a prolonged active life and independent living of an ageing population.
The goal of the project is to develop a services layer for integrated home care systems, referred to as the U-Care platform, which provides tailorable, evolvable and non-intrusive care services. The U-Care platform provides technology-independence, in the sense that it shields the service users from underlying software platforms and network solutions, and it encapsulates existing care and well-being applications. The creation and provisioning of services will be based on pre-defined service building blocks, which provide basic context-aware functions, by utilizing information derived from sensors for biosigns (activity level, heart rate, blood pressure, oximetry, weight, etc.) and sensors for context (location, temperature, humidity, etc.). The services are targeted to wellness and care applications to assist people of 50 years and older in an "integrated living" environment. Typical applications are in emergency monitoring, lifestyle monitoring and advice, exercise monitoring and co-training, and enabling social interaction.
The U-Care project addresses the following technical problems:
- current automated home care support systems are often technology-driven, with the inherent drawbacks of being hard to use by the non-technical end-user, difficult to manage by the service providers, and hard to change or adapt when new requirements have to be met.
- technology solutions currently on the market are generally very specific and dedicated to a single goal, resulting in multiple non-interoperable systems in case a range of care conditions needs to be addressed.
- most systems cannot be tailored to the particular and often changing needs of their users, or do not (automatically or through manual intervention) adapt to fit their daily routines and personal situations.
The expected results of the project are:
- a validated conceptual model of the user environment, identifying stakeholders, their interests, responsibilities and relationships within the relevant care-giving and care-receiving processes (especially capturing the "integrated living" concept), and considering the role of the U-Care platform in this environment. To a lesser extent the model also addresses issues of governance, ethical and legal compliance, and social desirability.
- a (set of) validated scenario(s) for using wellness and care services, involving all stakeholders, and situated in an “integrated living” environment.
- a service-oriented architecture for the U-Care platform that provides maximum tailorability, evolvability, non-intrusiveness and technology-independence. Tailorability will be supported by a service creation environment, which offers a healthcare domain specific configuration interface and which uses service discovery, selection and composition capabilities. Evolvability and technology-independence will be supported by the conceptual modelling approach in combination with service-orientation. Non-intrusiveness will be supported by context-awareness, which enables automated detection of and reaction on changing user situations.
- a method for the definition and development of wellness and care services, that uses the proposed conceptual model and service-oriented architecture to enhance alignment between the technical system and its social context.
- a set of basic context-aware wellness and care services, which can be used as building blocks in creating and composing user-tailored services.
- a prototype of the U-Care platform, which implements the proposed service-oriented architecture on top of a selected software platform (e.g., OSGi) using Web services standards. The prototype is a proof of concept, which will be validated using realistic scenarios provided by the health partners in the consortium.
The proposed research relates to a number of research themes, among which we briefly mention the most relevant ones.
With tailorability we mean the ability to adapt to changes, where changes can be dynamic contextual changes or changes in the (relatively static) functional requirements on a system. For this project, we consider the following motivations for tailorability:
- health problems of individuals change over time (in the case of elderly people, health problems normally increase). Such changes call for different types and combinations of services at different points in time. We advocate that a composition of services supported by a service-oriented architecture presents a promising solution to this problem. (As opposed to replacing one dedicated system by another one.)
- different individuals have different preferences and needs with respect to lifestyle and health. We think that also here a service-oriented architecture can help to flexibly compose services that fit the personal situation. In addition, services should be properly parameterized, such that each service can be configured according to preferences and needs. (As opposed to custom-made development and deployment).
Tailorability has been studied extensively in connection with specific technologies and applications (e.g. component-based systems, CSCW applications, user interfaces), but not so much in relation to wellness and healthcare services in the home environment. The specific user requirements, involvement of many stakeholders, financial boundary conditions, and fit to a relatively new architectural paradigm poses many new challenges.
A Service-oriented architecture (SOA) describes the functionality of a system as a collection of self-contained services, which can communicate with each other when required. The appeal of SOA is multifaceted, but essentially stems from the fact that service consumers do not need to be configured to locate and use services, and service providers can make themselves and their new services instantly known.
Although SOA has been around for some time now, and Web services has evolved as a popular and stable instantiation of SOA, many challenges are still ahead of us and motivate an active and large research community.
With respect to healthcare, SOA strategies have already been successfully applied, especially to integrate information and systems spread across different institutional partners' facilities. Service-oriented architectures for user-tailored homecare have however not yet attracted much attention and have not been systematically explored for effectiveness to reduce costs and improve care.
Context-awareness has emerged as an important and desirable feature in software applications. This feature deals with the ability of applications to utilize information about the user's current situation and needs. Context-awareness in general requires infrastructural support to accomplish cost-effective context information gathering and delivery. As a consequence, a number of middleware solution with context-aware support have been developed over the years, including Context Toolkit, Solar, Pace, JCAF and CMS.
We define context middleware as an intermediary software layer, between context consumers and producers, and communication platforms, which has as goal to reduce the complexities of distributing context information to facilitate the development of context-aware applications. A number of context-aware middleware systems that have been proposed in literature are:
Partners in the U-care consortium have intensively contributed to the Freeband Awareness project. The objective of Awareness is to develop a middleware-based infrastructure to facilitate the development of context-aware, mobile applications. Different context management solutions have been developed in the Awareness project, which will be considered within the U-Care project regarding their suitability for context-based tailoring of homecare services.
Since the term has been launched by IBM in 2001, a whole new realm of ICT research has emerged. The concept of self-management is addressed in many projects, and many architectures and solutions have been proposed and researched, .
The U-Care project can built on the results achieved, and brings it a step further in the sense that the principle of autonomic computing can be applied to the service building blocks and platform, as well as each individual care and well-being service. However, the even bigger challenge addressed by the project is on the control and management of end-user service interactions.
With context awareness, service tailoring and the application domain specific end-user services and applications, a representative complex ICT system is researched, in which closed control and management loops at various levels (local versus distributed, and infrastructure level versus application level, and body function vs. activity vs. participation related services and applications) exist and their interdependencies are studied, and optimized.
E-health and telemedicine services
E-health and telemedicine research so far primarily focused on very specific patient groups, and the ICT systems designed, prototyped and trialled are often dedicated to the monitoring, analysis, decision support and feedback regarding specific health conditions. Similar observations hold for end-user activity guidance, stimulation and feedback services.
The U-Care project takes an end-user driven approach where end-user needs (and variability in these needs) are identified, and the U-Care platform fulfils, and adapts to, evolvable end-user needs.
According to the ICF model, participation is very significant in care and well-being. ICT supporting elderly participation adds to their experienced care and wellbeing. Research in this specific application domain is hardly seen, though in a broader sense numerous stand-alone or closed solutions and platforms exist. The U-Care project researches applications and services that stimulate participation and activity, and support body functions, especially in the context of elderly care.
To the best of our knowledge, there are currently no research projects that take the stakeholders and the end-users of the system as the starting point and leading approach, and in which a more holistic view on health is taken and used to research ICT systems for the support of elderly care and well-being.