er, by the year 2005. Germa
ny is the worse right now, 14 percent are over 65 or older, in Japan, 9 percent. In the U.S. 10 percent.
But in the year 2000, it's going up to, in Germany, 16 percent, USA, kind of flat at 11 percent, and Japan will be 12 percent over 65 years old. And in the year 2010, Germany 18 percent, Japan, 17 percent, and USA, 13 percent. By the year 2030, in both Germany and Japan, 24 percent, and in the U.S., 17 percent will be over the age of 65. The U.S. is relatively OK, but you have to take into account cultural differences. In this country, once your parents are bed ridden, they are sent to nursing homes. But in Germany or Japan, they still try to take care of them in the home.
BYTE:
People that are now in their 30s, with no kids yet but hoping to have children soon, might look at the year 2005 or 2010 and see themselves caught between two areas, where you're taking care of young kids and older parents. It sounds like this technology could help out in both areas.
Asada:
Right. And the ratio of elderly to the young generation, in particular people in the age group of 35 to 45, versus the elderly is very critical. In the U.S. case, that ratio is very bad. In ten years or so, the baby boomers are all going to retire. The bottom line is we can't continue the current practice of elder care. We're going to have too many elderly and too few younger people who can take care of them, to do things like move the patients out of bed. That's why we need new technology. We are creating momentum in working with those home health care agencies, and they are very ecstatic about this and I hope we can deploy this technology in real places.
In a sense the home automation movement is a fad. What is unique in our project is that we look at the health care applications and we look at the home-based health care, in particular, we look at elder care in individual homes. So not just in general home automation, we look at practical applications in the health c
are area.
The home health care business is really booming. There are over 14,000 home health care agencies in this country, which includes small ones to big ones, the nationwide networks, and quite a few nursing homes are involved in it. But it's really growing rapidly and the estimated annual expenditures of the whole country in the home health care area is over 30 billion dollars a year, and that's a substantial part of the GNP here. Now, they don't have a lot of technology in the home health care area. They are doing very labor intensive jobs, and home care providers must visit the individual home. And that's very much a time consuming job. And also patients have to arrange rides to visit the doctors, clinic, or whatever, and that's a very difficult thing.
BYTE:
Could you describe your efforts to improve home health care automation?
Asada:
We start with very simple stuff, just to provide very simple teleconference and we are putting a very small uni
t, just a home computer and a small camera on top of it, in the individual patient's home. We hook it up to the internet through ISDN, and it's very cheap, and nothing new really, and there we just use available technologies. But the outlook is enormous that healthcare professionals can visit a bunch of patients' homes virtually. First we actually facilitate the communications between the patients, the elderly bedridden, to the nurses and doctors. This is a very convenient thing.
BYTE:
What about bedridden patients who need assistance?
Asada:
Just teleconference doesn't solve the whole problem. The elderly do need some physical assistance. But we found out that you can't bring in a very sophisticated system into the patient's home abruptly. You have to go through it step by step. And the first step, which is very easy and quite feasible to do at this time, is the Internet connection. That's what we call Level One. Once the patients accept that, we go to Leve
l Two. And in Level Two, we provide a bunch of health monitoring sensors such as the blood pressure measurements, EKG (electrocardiogram), very simple stuff, but the point is that all these sensors are hooked up to the Internet so that the doctors and nurses can monitor the health status remotely. We are developing simple and easy to use new sensors for health status monitoring to be used in individual homes. That's Level Two. Once they accept that, we move on to Level Three. In Level Three, we provide some physical assistance, such as for the bedridden patients, to help them move out of the bed, go to the toilet, and take a shower, and how to do some daily jobs, and they need assistance. What we are doing is to develop the advanced chair-bed systems, and we provide the pieces of equipment to the individual patients. Again, the patients are all supervised by care givers and assistants because we already installed the information network and we can monitor the health status remotely. And on top of that, we pro
vide physical assistance devices.
BYTE:
Could you tell us about these new devices that you're developing?
Asada:
We are in the process of developing a pretty sophisticated machine, a hybrid wheelchair/bed system where the patient doesn't have to move out of the bed. The bed itself can move in an omnidirectional way so that the patient can go to the toilet and dock to the toilet directly so that the patient doesn't have to change his seating. As you know, changing the patient's seating is quite difficult, it can be quite difficult to pull a large patient out of bed. That is very much a physical job, and many caretakers are women who are in some cases unable to do it unless they work in a team with two or three people. That is an extremely labor intensive job. So our equipment, this hybrid bed and chair system, really eliminates that labor intensive job, so that the bed becomes a chair. The chair is docked to a bed system, and then it becomes a bed. And if you
want to go to the toilet, that chair portion is detached from the bed and it has wheels and it automatically navigates to a toilet. And then it docks to the toilet directly. It's sort of scarey or frightening for those elderly to use this sort of machine, so we are extremely careful in providing such facilities. This is why first we must provide monitoring and communications first, followed by this, that is our strategy. We want to ease the patient into all of these high-tech assistants.
BYTE:
What about human feedback over the course of the day that the elderly might want?
Asada:
Beside the chair, we have a small monitor TV and in the TV a caregiver shows up and the caregiver talks to the patient while the bed is moving, so it's sort of a kinship, so that the patient has a real sense that he or she is always attended to by someone without that person having to move into the home.
BYTE:
So the person in the TV would be saying things
like, "How are you doing today, Mr. Jones?"
Asada:
Exactly, when in case of emergency or something wrong happens, the caretaker steps in and changes or modifies actions as needed at the time. But something that is very important is that we recognize that there will be product reliability problems and there are many safety issues, so someone, a human must be part of the home care loop at least to some extent. This effort is supported by many of the nursing homes in the Boston area, and our plan is to deploy this system to some of the nursing homes by the end of this year and do some beta tests to see how they feel about it. But it's challenging stuff in that those elderly are not always able to catch up with the technology advances, and they never thought about the Internet or teleconference systems, and it's hard to imagine from their standpoint.
BYTE:
The Level Three device that you're developing, is there any idea as to when this will be commercialized?
Asada:
The elder care project is part of our big consortium project and this is a two-year project and we're hoping those things will be commercialized in two or three years. The information, the remote monitoring parts of the program will be deployed this year.
BYTE:
What are some of the other technical developments you are working on?
Asada:
I think there going to be quite a few new devices available to monitor patients' health status. We are developing, under this consortium, extremely small sensors that can be worn comfortably by the patients, called MEMS (micro electromechanical sensors). And we can miniauturize those sensors drastically, so that you can embed sensors in clothing. We are talking about instrumented pajamas, so you can put the probe to get the very fine sensor to monitor your heart activity, or we have a sensor to measure blood pressure very comfortably. All of these things are very possible. By miniaturization tech
niques, we can build sensors into even chairs. Then we can obtain various pieces of information on the patient and on the basis of that, we are building a computer model of the patient, what we call the virtual human model. The virtual human model is a very ambitious project involving the consortium. Basically we integrate the various technologies and sciences such as anatomy and physiology to build a computer model that can predict a particular patient's behavior. Once we have this tuned, this virtual human model, will be tuned to a particular patient, such as a bedridden elderly. And we aggregate the whole medical and personal data into this virtual human model. And there are many applications of this. First of all, this can be a database to store all of the medical data. Currently, this type of data, such as X-rays, is owned by the hospital. We think this is kind of a terrible thing that they want to hold such information, from our point of view, we think this ought to be a personal ... At this time, we do
n't have any means to store such data, and what we are proposing is to develop computer software for this home computer so that the whole medical data and track records can be stored in digital form. Similar ideas have been floating around, but what we are doing is to incorporate the medical data with the many home automation, elder care, home based health care issues. With the elderly, we already have a bunch of information, such as the track records that the particular patient has, such as a particular patient has a problem with the heart, or he or she has been having backaches, or some particular part of the body is not normal. We have to know all these particular pieces of information to provide the right services. So in addition to those things we actually think that this home computer, storing the virtual human model, is a very important part. So that way all the sensor data and those health monitoring systems are interoperated with the virtual human model.
BYTE:
So at some poin
t you'll get your X-ray and bring it home on a floppy drive that can store such data.
Asada:
That's right. And the patient must be able to have access to it. Perhaps the X-ray may not be a very important thing for the home based health care, but all kinds of other tests can be aggregated into this virtual care giver or virtual home doctor. And actually that can be coordinated with hospital-based health care too. But anyway, how this will be coordinated is sort of a side, not the main track of our elder care project, but I am saying all these things are possible.
BYTE:
Could you describe Level 4?
Asada:
Level Four is general maintenance, not just moving the patient around and assisting them, but we also have to provide general household services such as cleaning a room, and right now, home health providers are actually complemented by people who help the patients at home. That includes cleaning up, room service. Level Four, I don't k
now when it's going to be avaiable, but in the future, we'll act to provide that service. And this is not an easy job.
A home is a very unstructured environment. It's not easy to automate as you do factories and other more structured environments, so we have to take a different approach. And the first thing that we are doing at MIT right now is to complete the home inventory. What this means is just like in a factory, you know all the items in a factory or assembly line, you know how many parts are there, and what you use these parts for. So you have all these pieces of information. At home, no, these parts are scattered around, it is a totally unstructured environment. So the first step toward the complete home automation, what we are doing is to make the complete inventory. And that includes two technical issues. One is basically we are using a sort of simple bar code system where we use invisible bar codes that uses a special ink so we can identify all the items in the home. And also, bar codes are
printed at a particular location on each item so you can identify and locate the object. This actually allows you to get rid of the machine vision perception problem. We're using an object identification and listening systems. So we are combining transponders and we are embedding small chips that can respond to you if you wish so you can actually call to some items, you can locate that item, and again, we are using MEMS technologies. Some chips are passive, having no batteries in them that can be activated by responding to some particular height or weight.
BYTE:
So this will allow robots that are going around cleaning up to know details about various objects?
Asada:
Exactly. A robot cleaning up the floor must know what's in the floor and how to avoid it. You have to know the environment. And what I mean by environment is that you need knowledge about each item, and that's actually involved in the inventory, and we are building a database to describe all knowl
edge about each item. So if you look at the kitchen and the glassware, it has its own ID. If you encode the objects with a bar code, you can locate it and identify what it is. In looking at the database, you find what it is, like, this is a wine glass, and you also know that there are some do's and dont's. Like if the device is cleaning up and washing it, the robot has to carefully handle the wine glass, you can't try to force it into the dishwasher or you might get breakage. So all these things are provided in the database. Once we have the database, it is really quite easy.
We are building some home robots, what we call Robo-Maid, having two arms and an omnidirectional vehicle, and Robo-Maid knows all items within the house, and Robo-Maid can locate all the stuff there. So that if the bedridden patient wants to have some meals, Robo-Maid opens up a refrigerator that has its own inventory, so Robo-Maid knows what's there. Robo-Maid will know how much milk you have, and in the case where the milk is to
o old, Robo-Maid will discard it and include it in a shopping list of things that must be purchased from the supermarket. So you see why the home inventory is a central piece of the effort. So we hope that the home inventory and Robo-Maid project will be developed in two or three years.
[Editor's note: You can get more information about the Home Automation and Health Care/Elder Care Consortium at asada@mit.edu]
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How Computers Will Solve the Health Care Crisis
