Aendekerk, B

De Backere, Femke

Elprama, S

Jacobs, A

Luyten, K

Van den Bergh, J

English

Ghent University Academic Bibliography

Interdisciplinary Design of a Pervasive Fall HandlingSystemA case studyJan Van den Bergh, Kris LuytenHasselt University - tUL - iMindsExpertise Centre for Digital MediaWetenschapspark 2, Diepenbeek, Belgiumfirstname.lastname@uhasselt.beShirley Elprama, An JacobsVUB - SMIT - iMindsPleinlaan 91050 Brussels, Belgiumfirstname.lastname@vub.ac.beBrenda AendekerkWit-Gele Kruis Limburg VZWWelzijnscampus 253600 Genk, Belgiumbrenda.aendekerk@limburg.wgk.beFemke De BackereDepartment of Information Technology (INTEC)Ghent University - iMinds, Gaston Crommenlaan8 bus 201B-9050 Ghent, Belgiumfemke.debackere@intec.ugent.beABSTRACTFalls among elderly are an important concern as they impactthe capability to live independently. Falls do not only havea negative impact on one’s physical well-being, an increasedrisk of falling also has an important impact on one’s psycho-logical well-being. A context-aware fall handling system canmitigate many of the problems of falls by facilitating timelyand appropriate handling of falls.In this paper, we present the results of an early explorationof using context as part of fall detection and resolution ser-vices in Flanders, Belgium. We put specific emphasis onthe role of diverse disciplines during the process and reflecton their influence on the outcomes. We believe that thesereflections could be more generally applicable for interdisci-plinary research projects.Categories and Subject DescriptorsD.2.1 [Requirements/Specifications]: Elicitation meth-ods (e.g., rapid prototyping, interviews, JAD); H.5.2 [UserInterfaces]: User-centered designGeneral TermsDesign, Human FactorsKeywordsContext awareness, fall handling, interaction design1. INTRODUCTIONFalls among elderly are a problem, as they can have bothphysical as psychological consequences. Elderly can ask forhelp after a fall by using a Personal Emergency ResponseSystem (PERS). This is small device consisting of a buttonand a receiver. Elderly can wear this button around theirneck or wrist and press it in case of an emergency. The re-ceiver will send the signal to a call center and opens a 2-wayspeech/listen connection between the person in emergencyand a second party, in our case a qualified care organiza-tion. The performance of this system, though already veryuseful, is far from perfect and there are several ways to im-prove upon it. One way is to integrate automated sensors,e.g. camera-based fall detection [3], microphone arrays [5]or wearable sensors [1], another way is working on the oper-ating procedures when a fall is detected. This paper focuseson the fall handling procedure during which patients will beprovided with appropriate help through a call center in theprovince of Limburg, Belgium. Currently, a desk operator,which in this case is always a trained, practicing nurse, willbe put in contact with the patient and, in case this is needed,will call contacts (such as family members and neighbors) ina given order, until one is able to go to the patient’s home.One way to save time is to skip the entire call center andimmediately inform all contacts with a picture of the situa-tion and the option to start a live video stream as proposedby the incubating start-up FamilyEye 1. This has the limi-tation that a relatively close social network (both in termsof relationship and space) is required. Furthermore, it isdifficult for contacts to judge the situation when they lackin-depth medical knowledge. The Florence project 2 takesanother approach by letting a robot do a first diagnosis andprovide information to a call center. They did not investi-gate further call handling.We propose to keep the call center as part of the process and1http://www.familyeye.be/2http://www.florence-project.euFigure 1: Structure of the design used during the last interviews. Subsequent iterations information hadadditional information added all parts except part 1. Note: The actual designs had a more finished look.in control of the fall handling procedure, but we propose touse a mixed initiative approach [6] in which the interactivecomputing system, desk operator and (informal) caregiverscooperate to select the most appropriate contact. This ap-proach exploits certain dynamic (context) information about(informal) caregivers, gathered using a smartphone, such aslocation or availability (based on calendar or ringer profile)without interaction from the user. Given this richer informa-tion, one can let the system automatically order the contactsand increase the chance of quickly contacting a person thatwill attend the patient.This paper discusses our findings on working procedures anduser interface for the desk operator to take advantage ofcontext-aware information available through current tech-nology using such a mixed-initiative approach. Interviewswith nurses and other employees of a home care organiza-tion provided input for the redesign, by presenting and dis-cussing prototypes of the interface with them. We concludethe paper by some lessons learned both regarding fall han-dling and the user-centered inter-disciplinary approach usedto design the fall handling procedure and interface.2. APPROACH2.1 MethodologyTo learn more about the context in which the desk operatorswork, we did a contextual interview in the call center of ahome care organization. This organization provides PERSas a service to their clients. At the call center, a desk oper-ator showed us the alarm and the receiver, explained us indetail how PERS works and what procedure the desk opera-tors follow once they have a call. We observed several timeshow they handle false alarms as they received a couple falsealarms during our observation.Based on the initial view on the current workflow, human-computer interaction researchers created a first interactiveprototype using Indigo Studio, a software package to createprototypes and wireframes. This prototype was first shownto a researcher of the home care organization. During this‘dry run’ a domain expert from the home care organiza-tion tested whether the prototype was clear. Based on herfeedback, we made some changes to the prototype, such asadding the phone number (lower left in Figure 1) about thepatient.We had three sessions with in total eight interviews (2 male;6 female) to do formative evaluations of the designed userinterface (Figure 1). The interviewees were all working atthe home care organization and they had the following roles:six were home care nurses and two were support staff. Thelatter perform non-medical tasks to alleviate the work loadof the nurses. Both participating members of the supportstaff install the PERS at patient homes, one also attendscalls when there is uncertainty about the need for medicalfollow-up. All interviewed nurses had a specialization: twoworked as a desk operator and four were specialized in fallprevention. The age of all interviewees ranged from 22 to 62years old (mean = 39.6 years; s.d. = 15.4 years).After each of the three sessions, we used the gathered feed-back to improve the prototype, which was used during thenext session. During each interview, we briefly explainedthe context of the project followed by an introduction of theredesigned interface on a tablet. We asked each intervieweeto explain what they saw on the screen and to give theiropinion about it. After discussing the general interface, wewalked the interviewee through each element of the proto-type in more detail and asked them for feedback. Examplequestions include: “Does this part of the user interface pro-vide value?”, “Is there information missing?”, “When do youneed this information?”). Finally, we asked them to give anoverall impression of the prototype. During each interview,notes were taken and each interview was recorded on audio.Screenshots of the prototype’s interface were printed on pa-per to quickly note comments related to specific parts ofthe interface. As the changes made in between the sessionsgot positive feedback, we did not show older versions of theprototype to the interviewees.2.2 Research teamThe approach outlined in the previous section was executedby a research team spread over several research groups andorganizations with expertise from different disciplines: socio-economic impact of new technologies (SOC), human-computerinteraction (HCI), engineering (ENG) related to (a.o.) falldetection and smart reasoning systems. The work reportedon in this paper was primarily carried out by HCI and SOCresearchers. The contextual interviews were led by a SOC re-searcher with contributions from HCI researchers, while theHCI researchers led the interviews and prototype creation.The other disciplines were invited to give feedback on thecreated prototypes and were informed about the results ofthe interviews, including comments on the prototypes.3. RESULTS3.1 Current approachThe initial observations in the call center and the informa-tion received at this stage, informed us about the overallworkflow of handling a call, which sufficed to get a goodinitial understanding of the call handling protocol. The cur-rent protocol is to have a list of five3 contacts (such as familymembers or neighbors) that will be contacted once a patientneeds help. These contacts indicated in which order theywant to be contacted in case of an emergency. Unless thepatient especially requests a specific person to come or incase contacts indicated they would be on holiday, which isfrequently forgotten, this order is respected. However, thismethod has some disadvantages as contacts are not alwaysavailable or are too far away to quickly reach the patientafter a fall.Once a patient presses the alarm button, the details such ascontact information of this patient are shown on the com-puter of the desk operator at the call center. Informationthat is shown includes the list of contacts but also specificinformation like ‘has diabetes’ or ‘does not hear well’.Interviewees indicated priorities and selection rules that ap-ply in handling in fall;1. Is there a fall? There are many (intentional) false pos-itives using the PERS system as patients are expected3This was the ideal number for this particular alarm central,other centrals might prefer up to 10 persons. Patients mayhave less contacts.to regularly check correct operation of the system andthey sometimes accidentally press the alarm button.2. Can all contacts enter the patient’s home? If not, thefirst priority is to find someone with a key to the pa-tients home, starting with the preference of the patientif expressed or following the order established by thecaregivers.3. Who to contact? If the patient’s home is accessible,two other questions need to be answered that needmore information than available in the PERS: what isthe severity of the fall and who can attend the patient?If no unique answer is available, the desk operator goesthrough the list of (available) caregivers and the firstone who answers, who is also available and not too farfrom the patient, is the one that goes to attend thepatient.4. What was the result of the intervention? The resultsof all handled calls are logged for future reference.The fall handling procedure ends when a caregiver at thepatient’s home reports the results to the desk operator.3.2 Context-awarenessThe interviews delivered several useful insights regardingcontext-awareness. We can divide the context informationin three categories: fall context (Can the patient respond?Where did the fall occur? Is there resulting pain? Is thepatient mobile?), contact context (Which contacts are avail-able and how quickly can they get access to the patient’shome?), and call context (What was the reason for the calland what actions have already been taken?).3.2.1 Fall contextPart 3 of Figure 1 was used to trigger reactions regardingcontext information related to the fall.Showing the picture of the user lying down on the groundafter the fall can give the desk operator a better idea aboutthe urgency of the incident and possibly injuries from thepatient. Yet interviewees mentioned that the patient shouldgive consent to show the image unless no contact could beestablished and patient safety could be in danger. Anotherconcern mentioned was that the desk operator should notmake the diagnosis. Having such concrete information couldthus also distract from the actual task which places thisresponsibility to a person on site.Some interviewees indicated that showing something like astick figure instead of the actual image / video could be analternative that was considered less of an intrusion regardingprivacy but could reveal similarly useful information. Anindication of the place where the patient fell was consideredat least as important as it would allow the contact comingto help to more quickly locate the patient.3.2.2 Contact contextContextual information about contacts (Figure 1, right: color-coded status and distance) was greatly appreciated, althoughsome had doubts how many would be willing or would forgetto provide certain information (e.g. regarding availability).We repeatedly heard remarks related to the lack of updateson longer absences by contacts.We also heard several stories related to repeated phone callsto contacts that were in the end not reachable or could notattend the fall. This results in several minutes of time lost,especially since contacts can have multiple registered phonenumbers such as fixed line and mobile phone(s).Having automated updates regarding availability and loca-tion were thus greatly appreciated. Interviewees were scep-tical regarding manual updates to the status of contacts.3.2.3 Call contextIn the current fall handling procedures time-outs and regularphone calls are really important to ensure proper handling ofa fall. Interviewees would welcome more technological assis-tance including (semi-)automated notifications when some-one arrives at the site or when the fall is handled. For ex-ample, knowing that someone is stuck in a traffic jam couldreduce the number of potentially inconvenient phone calls(e.g. calls while contact is driving).4. DISCUSSIONThis paper explored the benefits that context-awareness couldbring to a fall handling system through a user-centered ap-proach, which used a focused interactive user interface proto-type and (primarily) semi-structured interviews. The quickiterations proved useful as consecutive interviews could con-firm information from earlier interview and in some casesbuild upon it. The involvement of several disciplines inthe process (section 2.2) was valuable because they hadlargely complementary but also partially overlapping skillsand points of view for carrying out the research. Further-more they were open towards the needs of others.We believe it was beneficial that the interviewees had dif-ferent roles in fall handling as it lead to richer insights dueto the complementary experiences with the system. Whileonly a minority was desk operator, most could contributenew insights and/or confirm those provided by others. In-terviewees that had more experience in attending falls, couldgenerally provide useful information based on this. For ex-ample, several testimonials detailed the need of key accessto the house of an elder.The research disciplines (section 2.2) involved in the designof the context-aware system worked in parallel on both thetechnical and user side of the project. This posed prob-lems despite regular meetings, a shared vision document andworkshops involving the diverse disciplines. Several reasonscould be identified, which can be more prevalent when work-ing in interdisciplinary teams; working rhythms and commu-nications may not always be sufficiently adapted or specified.For example, a realistic estimate of what sensor-derived in-formation could be represented in the user interface was noteasy to identify partly because this research is carried outin parallel and there were still uncertainties regarding theresults that could be obtained.Regarding communication it is difficult to abide to the threelaws of professional communication [4] as the required infor-mation and the way it should be presented in an interdisci-plinary team can be highly different from what is needed orexpected when communication within one’s own discipline.Context-awareness was strongly appreciated because it couldprovide the desk operator, contacts and nurses with relevantcontext information. The interviewees were convinced thatadding awareness of the location and reachability of (infor-mal) caregivers could reduce the time it takes to handle afall. Interviewees were more critical towards the automatedinclusion of images or video about the fall, mainly due toprivacy and related acceptance concerns.Future work within the project will focus on further investi-gation on the opinions of non-professional stakeholders (con-tacts and patients) on the proposed approach, especially re-garding the focused gathering of the contextual data, suchas availability and location in the context of the fall handlingprocedure. The resulting approach could be integrated in anoverall platform [2] to combine the context-aware fall han-dling mechanism proposed in this paper with enhanced falldetection approaches that deliver fall context information.5. ACKNOWLEDGMENTSThe iMinds FallRisk project is co-funded by iMinds (Inter-disciplinary Institute for Technology), a research institutefounded by the Flemish Government. Companies and or-ganizations involved in the project are COMmeto, TelevicHealthcare, TP Vision, Verhaert and Wit-Gele Kruis Lim-burg, with project support of IWT.6. REFERENCES[1] G.-C. Chen, C.-N. Huang, C.-Y. Chiang, C.-J. Hsieh,and C.-T. Chan. A reliable fall detection system basedon wearable sensor and signal magnitude area forelderly residents. In Aging Friendly Technology forHealth and Independence, pages 267–270. Springer,2010.[2] F. De Backere, F. Ongenae, F. Van den Abeele,J. Hoebeke, S. Verstichel, A. Ackaert, and F. De Turck.Social-aware and context-aware multi-sensor falldetection platform. In SWAT4LS, 2013.[3] G. Debard, P. Karsmakers, M. Deschodt, E. Vlaeyen,J. Van den Bergh, E. Dejaeger, K. Milisen,T. Goedeme´, T. Tuytelaars, and B. Vanrumste. Camerabased fall detection using multiple features validatedwith real life video. In Workshop Proceedings of the 7thInternational Conference on Intelligent Environments,volume 10, pages 441–450, 2011.[4] J.-l. Doumont. The three laws of professionalcommunication. Professional Communication, IEEETransactions on, 45(4):291–296, 2002.[5] Y. Li, K. Ho, and M. Popescu. A microphone arraysystem for automatic fall detection. BiomedicalEngineering, IEEE Transactions on, 59(5):1291–1301,2012.[6] N. Mahmud, K. Luyten, and K. Coninx.Mixed-initiative context filtering and group selectionfor improving ubiquitous help systems. In AmbientIntelligence-Software and Applications, pages 155–162.Springer, 2012.

Interdisciplinary design of a pervasive fall handling system

De Backere, FemkeCA05TW050020032268228020006024460000-0002-0768-494909AED7E4-F0EE-11E1-A9DE-61C894A0A6B4

Interdisciplinary design of a pervasive fall handling system

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