Technology will help ease, but not replace, rising workforce demand in long-term care: UCSF study

A just-published research paper by researchers at the University of California, San Francisco Health Workforce Research Center on Long-Term Care, has come to the not entirely unsurprising conclusion that the current technology targeted to the LTC area is helpful but won’t displace any workers from their jobs in the immediate future. The qualitative study evaluated 13 current health tech technologies in 14 areas for their potential impact on the care of older persons as it affects LTC workforce recruitment, training, and retention. 

Some key findings were: 

  • Technology will not even come close to replacing the LTC workforce. At most it will aid LTC workers.
  • Tools such as data collection and remote patient monitoring systems that distribute data to the care team can improve staff’s understanding of client behavior and manage day-to-day tasks
  • Technology can also address workforce recruitment, retention, and staffing efficiency, such as predictive analytics used in identifying candidate suitability, improved staff management in shift scheduling, work location, and clientele, and real time location tracking, can improve the work environment
  • Technologies that monitor health and activity measurements, integrating with predictive modeling, can benefit clients, family caregivers, and care teams, but may suffer from complexity and duplication in their category. 
  • Educational tools also improve care delivery by instructing on proper caregiving techniques, increasing knowledge on medical or behavioral conditions, and by promoting sympathy/empathy

Some of the barriers included:

  • It comes at a cost which LTC is reluctant to pay
    • Initial and ongoing cost with lack of third-party Medicare/private reimbursement
    • Dependence on unattractive long term subscription-based models 
  • Threats to privacy and the security of health data
  • Potential differences in product specificity or acceptance among diverse racial and ethnic groups
  • Technology lacking user-centered design and not developed/tested in conjunction with real-world LTC 
  • Funding: only two US VCs fund LTC tech is a bit of an exaggeration, but the pool of interest is shallow nonetheless

The overall conclusion struck this Editor as less than enthusiastic, perhaps because We’re Not There Yet and it’s still so far away.

The appendix lists the 13 companies surveyed with summaries of each health tech company interviewed: Alma’s House (Sweden), Arena (staffing/recruitment), Canary Health (education/caregiver education), CarePredict (wearables/alert monitoring), Clear Care (management). Embodied Labs (education), Intuition Robotics (ElliQ), GrandCare (monitoring/client engagement), Honor (staffing), La
Valeriane (documentation), LifePod (voicetech/monitoring), UnaliWear (wearables/monitoring), VisibleHand (documentation/EHR).

The study was supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS).com. UCSF summaryThe Impact of Emerging Technologies on Long-Term Care & the Health Workforce (full text)  Hat tip to Laura Mitchell of GrandCare via Twitter

TTA’s Week: Eric Topol does the NHS’ future, robotic therapy for autistic children, telehealth’s wind at back, and Editor Charles’ roundup

 

The Topol Review’s relationship to reality explored by Roy Lilley. Robotics effects in therapy for children with autism and CP. The wind’s even more at the back of telehealth–but there are caveats. Plus Editor Charles is back with a UK digital health roundup.

And scroll below for news of The King’s Fund’s Digital Health and Care Congress–plus 10% off registration for our Readers!

Roy Lilley’s tart-to-the-max view of The Topol Review on the digital future of the NHS (This week’s Must Read)
Robots’ largely positive, somewhat equivocal role in therapy for children with autism and cerebral palsy (HIMSS)
The wind may be even stronger at the back of telehealth this year–but not without a bit of chill (VA, Virginia as indicators–and the hurdles when you get there )
A selection of short digital health items of potential interest (Editor Charles is back with views on AI and events)

The telehealth entrepreneur and the $5 million fraud = 15 years in prison. Scotland’s Current Health wins FDA clearance, Latin America telemedicine’s uncertain state, women in eHealth, and studies on digital health in health systems.

News roundup: Current Health’s Class II, Healthware Italy’s €10 million boost, the low state of Latin America telemedicine, weekend reading on digital health in health systems
Digital health versus eHealth: ‘here we go again’ with the confusion and the differences. Plus Women in eHealth (JISfTeH) (Reviving the terminology discussion)
The telehealth ‘entrepreneur’ whose $5 million funding bought stays at the Ritz and portfolios at Bottega Veneta (And 15 years in the Federal pen. Tell your mum or uncle to be wary of good stories)

Our lead this week is the sale of Tunstall’s US operation. Unicorns need to hype less and publish studies more. The King’s Fund’s two events in March and May, Bayer’s accelerator winners, and news from Apple to teledermatology for São’s spotted!

Short takes: Livongo buys myStrength, Apple Watch cozies with insurers, Lively hears telehealth and $16 million
Tunstall Americas sold to Connect America
(Tunstall conceding their business is outside the US)
Where’s the evidence? Healthcare unicorns lack the proof and credibility of peer-reviewed studies. (Unicorns need to add substance to the sparkle)
News roundup: Virginia includes RPM in telehealth, Chichester Careline changes, Sensyne AI allies with Oxford, Tunstall partners in Scotland, teledermatology in São Paolo
The King’s Fund ‘Digital Health and Care Explained’ 27 March
(Readers also get a 10% discount at the 22-23 May Congress)
Bayer’s G4A accelerator awards agreements with KinAptic, Agamon, Cyclica (DE) (A truly international accelerator program)

Latest through the revolving door is NHS’ chief digital officer, digital health may be more ‘bubbly’ than you would like, telemedicine and telehealth gain important consumer and Medicare facing ground, and fill your calendar some more!

NHS England digital head Bauer exits for Swedish medical app Kry, but not without controversy (The revolving door reveals a self-made cloud over her head)
Events, Dear Friends, Events: UK Telehealthcare, Mad*Pow HXD, dHealth Summit (Get out the calendars–and the checkbooks/app)
Telemedicine virtual visits preferred by majority in Massachusetts General Hospital survey (Over 94% loved the convenience alone)
Medicare Advantage model covering telehealth for certain in-person visits starting in 2020 (The needle moves–slowly)
It’s not a bubble, really! Or developing? Analysis of Rock Health’s verdict on 2018’s digital health funding. (‘Bubbly’ factors that may influence this year–not for the better)

We round up the Official Healthcare Circus of CES, Verily rolls along with $1 bn in investment, and Walgreens Boots finally makes an alliance splash with Microsoft

It’s Official: CES is now a health tech event (updated) (And still a circus! We round up the top coverage so you don’t have to)
News roundup: Walgreens Boots-Microsoft, TytoCare, CVS-Aetna moves along, Care Innovations exits Louisville
Verily, Google’s life sciences arm, gathers in another billion to go…where? (Updated for Study Watch clearance) (Still a mystery)

Our first full week in January is full of news and events, from CES to RSM, plus lots of healthcare acceleration!

News roundup: CES’ early beat, CVS-Aetna pauses, digital health fizzes, Yorkshire & Humber Propels
Events, Dear Friends, Events part 2: Newcastle and Texas accelerate, Aging2.0 NYC gets happy, AutoBlock’s Meetup, Wearable Tech, HealthImpact East
Events, Dear Friends, Events: Hancock at the RSM, MedStartr NOLA Challenge, RSM and The King’s Fund

We start our 2019 first in West Africa with a health facility mapping initiative addressing epidemics and service distribution. On to the UK with Babylon Health’s chatbot problems revealing an increasingly fractious relationship with the business press–one of our most read articles ever. And 3rings may be exiting, but doing so with grace and consideration–another Top Read.

Healthsites, eHealth Africa mapping health facility locations in West Africa to improve emergency care (Fighting epidemics and improving disaster response using health tech)
Is Babylon Health the next Theranos? Or just being made out to be by the press? (Soapbox) (A few best practices might stop a growing pile-on–or a Big Problem)
3rings’ well-handled transition to their March shutdown (updated) (Referring their clients to other UK companies based on the customer’s needs) 


The King’s Fund’s annual Digital Health and Care Congress is back on 22-23 May. Meet leading NHS and social care professionals and learn how data and technology can improve the health and well-being of patients plus the quality and effectiveness of the services that they use. Our Readers are eligible for a 10% discount using the link in the advert or here, plus the code Telehealth_10.


Have a job to fill? Seeking a position? Free listings available to match our Readers with the right opportunities. Email Editor Donna.


Read Telehealth and Telecare Aware: http://telecareaware.com/  @telecareaware

Follow our pages on LinkedIn and on Facebook

We thank our present and past advertisers and supporters: Tynetec, Eldercare, UK Telehealthcare, NYeC, PCHAlliance, ATA, The King’s Fund, HIMSS, Health 2.0 NYC, MedStartr, Parks Associates, and HealthIMPACT.

Reach international leaders in health tech by advertising your company or event/conference in TTA–contact Donna for more information on how we help and who we reach. See our advert information here. 


Telehealth & Telecare Aware: covering the news on latest developments in telecare, telehealth, telemedicine and health tech, worldwide–thoughtfully and from the view of fellow professionals

Thanks for asking for update emails. Please tell your colleagues about this news service and, if you have relevant information to share with the rest of the world, please let me know.

Donna Cusano, Editor In Chief
donna.cusano@telecareaware.com

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Robots’ largely positive, somewhat equivocal role in therapy for children with autism and cerebral palsy (HIMSS)

A Georgia Tech study presented at this week’s HIMSS19 conference presented findings of an eight-week study of children with specific neurological conditions who were assisted by robotics in specific therapies for movement and cognition. The study began with the simple attraction of children to robots. Robots also don’t have the negative connotations of therapists, and in fact, based on the studies cited, robots  are more trusted than humans by both adults and children.

For a child, robots ‘repetitive and predictable interactions’ can be reassuring (like Pepper in a Belgium hospital two years ago) , along with ‘gamified’ therapies and child-robot direct interaction as well as therapist-guided. The study’s approaches took several forms:

  • Virtual reality therapy games
  • Guided physiotherapy in movement–gross and fine motor skills
  • Cognitive therapy to improve attention span
  • ‘Gamified’ therapy
  • Robot therapy coaching
  • Tablet-based games

At the start of the study, physical and cognitive baselines were taken and retested at four weeks. By eight weeks the difference in movement parameters between normally developing children and those with cerebral palsy had largely equalized. In a second study, when the robots were withdrawn, their improvement decreased, but not back to baseline. The researchers’ concern was of course, dependency on the robots for therapy on a long term basis. HIMSS presentation by Ayanna Howard, professor of robotics at Georgia Tech is currently online–view quickly as usually they are withdrawn shortly after HIMSS is over.  Mobihealthnews

Kompaï robotics gets FABULOS in EU Horizon 2020 automated minibus competition

France’s Kompaï robotics, which Editor Steve first profiled in May 2011 (!), is still developing assistive robots for older adults, the disabled, and their caregivers. In another instance of technology integration and crossover into an area other than healthcare, they are a finalist in one of 5 consortia of 16 companies competing in the European FABULOS challenge to develop an automated minibus. Kompaï is partnering with Actia Automobile as the Kompai-Actia Consortium. Phase 1 of FABULOS starts 1 January with a feasibility study with conclusions for the start of prototype development. In autumn, the consortia will move to lab testing prototypes with real-world testing of the final three starting March 2020 in Estonia, Finland, Greece, the Netherlands, Norway, and Portugal. The R&D is being financed by the European Horizon 2020 Research and Innovation Programme with a total fund of over €5,5 million. FABULOS release.

A critical take on Pepper’s Parliament Question Time (UK)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2018/10/103886629_mediaitem103886628.jpg” thumb_width=”150″ /]Perhaps this Editor should have been less credulous. Somewhere, this Editor failed to notice a mention in the press she picked up that Pepper’s Question Time before the Commons select committee on education had been fully prearranged and scripted. (Thank you and a Big Tip of The Hat to reader Alistair Appleby for pointing that out.) It made Pepper’s appearance a little less than All That Sensational–more like a pre-recording delivered by an automaton prompted through a Middlesex University student’s smartphone.

Mr. Appleby provided a link to a Wired UK article that bears close reading. It sharply critiques not only the presentation, but also the trivialization of what the select committee was really examining, which was the “Fourth Industrial Revolution” of large-scale automation and its disruptive effects on the work of the all-too-near future.

Wired‘s reporter Gian Volpicelli sat in the front row and acidulously observed that Pepper’s appearance was a PR stunt that detracted from the substantive (I think) conversation that preceded it.

“For one hour before Pepper’s triumphal entrance, three experts from UCL, Nesta and Siemens engaged just in that kind of nuanced, data-based, academic conversation with the Committee’s MPs. They studiously tackled issue after unresolved issue, from AI bias, to education reform, to pure epistemology. “What is knowledge? Why should we believe something?,” asked UCL professor Rose Luckin at one point. “What a wonderful philosophical discourse,” committee member William Wragg MP would remark – under the austere blue gaze of Maggie Thatcher’s portrait. “

It does sound like the usual academic drift-off into La La Land, making it a discussion on Big Issues That Make Your Head Hurt because they have a thousand possible outcomes out of H.G. Wells and Aldous Huxley, but what is remarkable is that neither BBC News nor the Guardian saw fit to mention the experts’ testimony.

Mr. Volpicelli rightly labels Pepper’s appearance a media stunt that gained all the attention versus a real discussion about the societal effect of future robots. Will it be the Pepper-future of cute machines that can perform few tasks and are non-threatening? Will it be the Atlas-future, the one projected by Boston Dynamics’ humanoid athlete-robot that does parkour and skillfully leaps large boxes, funded by DARPA to be a search and rescue robot? Will the future belong to the weirdly humanoid Frubber-skinned Sophia, who fell into the ‘uncanny valley’ at CES last January [TTA 23 Jan] — the same CES where Pepper ‘fainted’ to a non-working slump (schlump?) More than likely, it will be the robotic arm that flips and bags the fast-food burger that is more of the immediate future–and displacing low-wage workers–than any of the above. We need to have a very serious chat about Pepper’s pointless parliamentary pantomime 

Pepper pays a first-ever robot visit to Commons on the future of AI and robotics on education, older adult care (UK)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2018/10/103886629_mediaitem103886628.jpg” thumb_width=”150″ /]Pepper paid a visit to a House of Commons select committee on education and became the very first robot to meet with MPs. Accompanied by students from Middlesex University, where Pepper is part of an initiative on teaching primary school-level children, he made a short presentation about the future of artificial intelligence in education and older adult care.

Certainly his introduction has some historic value. Pepper bowed and then said in his rather high-pitched and somewhat Japanese-inflected voice: “Good morning, chair [Robert Halfon]. Thank you for inviting me to give evidence today. My name is Pepper and I am a resident robot at Middlesex University.”

Pepper used voice, gesture, and his embedded front tablet to explain about the role robots like him will play in education and healthcare. At Middlesex, final year students in robotics, education, psychology, and biomedicine like Joana Miranda, one of his two escorts, work with Pepper on projects such as developing numeracy skills in primary school students. According to BBC News, Tory MP Lucy Allan dryly noted that Pepper was “better than some of the ministers we have had before us”.

In healthcare for older adults, the Pepper robot developed by Softbank is part of a major research project funded by the EU, the Japanese Government and UK’s Horizon 2020. The objective of the three-year CARESSES program is to develop a culturally aware robot to provide care suited to a wide variety of individuals and reduce loneliness. Another desired outcome is to relieve pressure in hospitals and care homes by promoting independent living at home with a care robot.

The education committee is examining the “fourth industrial revolution” which impacts STEM education, school curriculum, and workforce skills (and reskilling). Videos on BBC News and Gevul News (YouTube) A tart take on Pepper versus PM Theresa May from The Guardian. (And no fainting, as Pepper did at CES earlier this year.) Hat tip to The King’s Fund weekly newsletter.

PARO: The robotic therapy seal that benefits so few

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2018/03/paro1jpg.jpg.size-custom-crop.1086×0.jpg” thumb_width=”150″ /]I have a problem with that cute, robotic seal cub PARO.

More accurately, I have a problem with the ethics of the business model of the Japanese company that makes it, Intelligent System Co. Ltd.

PARO started development in 1993 and the first English press release was in 2004 – a year before Telehealth and Telecare Aware started! Since then the indications that PARO is good for people with dementia have been building and building, as Editor Donna most recently highlighted in this item: PARO therapy robot tested, cleared by NHS for — hygiene.

I have no problem believing, as Donna summarised, “the research has shown that it lowers stress and anxiety, promotes social interaction, facilitates emotional expression, and improves mood and speech fluency.”

However, in response to an enquiry last week, it was confirmed to me that neither price or delivery time information is available but that PARO seals continue to be made individually, by hand. This is a huge production bottleneck and cost.

It is entirely proper for a company that produces handmade cars to have high prices and long waiting lists for their rich man’s toys but I am completely at a loss to conjure up any justification to apply that thinking to PARO. (PARO cost $6,400 in 2017.)

I believe that the insistence that PARO continues to be made in this way is an unethical denial of a benefit to millions of people.

Does Intelligent System not have the will or the skill to scale up production and bring down the cost so that every care home or dementia ward could acquire a PARO (or even a ‘PARO lite’) within a few years? If not, they should license it to a company that can.

At least they should stop pretending that PARO is benefiting people with dementia when it reaches so few.

This Telehealth and Telecare Aware Soapbox item is the personal opinion of TTA founder and Editor Emeritus Steve Hards.

Japan as aging bellwether: experiential VR, claim that robots increase activity by 50 percent

Japan’s population is the oldest on average in the world, with over 27 percent of its population aged over 65 and the highest average life expectancy at 83.7 years. Writer Shiho Fukada spent a year researching aging tech supported by the Pulitzer Center. In STAT, he profiles innovation in two areas we’ve highlighted previously: VR experiences for those who are restricted in their mobility and the effect of robots in elder care.

Bringing experiences to the older person. A Tokyo therapist, Kenta Toshima, takes videos of his travels to 29 countries and 55 cities, then shares them with his patients on a smartphone mounted on an inexpensive cardboard viewer to simulate full VR. His concept, Virtually Able, has positive results and he is trying to develop a study. Yet in the US, Dr. Sonya Kim has been developing this in a commercial model via OneCaringTeam and Aloha VR.  [TTA 21 Nov 16 and 11 Nov 17These VR experiences for residents of long-term care are being researched for easing anxiety, increasing positive feelings, stimulation, and connectedness in older people with mobility difficulties or dementia, with Cedars-Sinai in LA evaluating VR for pain reduction with mixed results.

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2018/02/Pepper-daughter.jpg” thumb_width=”200″ /]Robotics in monitoring and connectedness. It’s another look at Palro and Pepper [TTA 24 Oct 17], this time in action at the Flos Higashi-kojiya Senior Care Facility in Tokyo, at a nursing home run by the Social Welfare Corporation of Tokyo Seishinkai, and in a home with an older couple. Robots, as we’ve noted, are stepping in the care and connectedness gap.

  • For older adults living at home by themselves, interactive robots like Pepper can aid with tasks but as you’ll see in the video, the wide-eyed Pepper becomes a ‘daughter-bot’ (left and above from the video) that remarkably increases engagement between this older couple in a typically crowded Japanese home.
  • In Japan, as in the West, there’s a shortage of care staff able to engage with residents in senior living. In the video, Palro struts across a table to the admiration of a group of older women in assisted living and leads them in an exercise routine.
  • In a Tokyo nursing home, a Guardian desktop robot not only monitors the well-being of patients in nursing care using audio and video, but also communicates interactively with the patient to give a feeling of personal attention and encouragement. Mr. Fukada at 06:14 quotes a study that residents living with robots are 50 percent more active and that 70 percent without robots are less active, but unfortunately this is not footnoted.

What is evident is that Japan continues to pioneer in robotics for care of older adults and in general (CES), but the takeup in other countries, with some exception for Europe, is not that great–yet. Previously in TTA: Japan’s workarounds for adult care shortage, Japan’s hard lessons on an aging population

 

Robot roundup: doctor cars, teleworkers, robogiggers, errant NAO robots

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/01/Overrun-by-Robots1-183×108.jpg” thumb_width=”200″ /]This month your Editor’s been ‘overrun by robots’ in the news! Here’s the roundup for your end of August reading, with an emphasis on how humans interact with robot helpers, especially at work:

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/08/7-who-needs-a-hospital-when-this-self-driving-doctor-comes.jpg” thumb_width=”150″ /]The doctor’s car has been around since the 1904 Buick, but the Seattle firm Artefact takes it one step further by combining the self-driving car with a fully automated clinic on wheels that arrives at your home, minus the doctor. Step in and it takes your weight, BMI, posture, respiration, and other sensor-based measurements guided through augmented reality instructions. It has a telemedicine interface in case you need a live virtual doctor. Medication? It’s a dispensary on wheels. Treatments? It will take you to a real doctor or provides AI-driven comparative information on treatment options. Artefact’s concept is part of their endless health monitoring continuum of care, which far more than the Doc Car is a little…creepy. FastCompany Design

Many of us are remote workers, but what if you could be in the office via a telepresence robot? A writer for Wired adopted an EmBot from Double Robotics so she could ‘be in the office’ in San Francisco while living in Boston. Her adventures with human-robot office interactions, developing relationship protocols, self-identification with it, and its many foibles (technical and otherwise) are a hoot. Hat tip to TTA Founder Steve Hards

Clark Kent would activate a robot to take his place at the Daily Planet while dashing off as Superman. Could a robot be your cyberself, working to provide you with an income stream in retirement? Or could you invest in robots working in the short-term robo-gig economy? Joseph Coughlin of MIT’s AgeLab in Forbes is quite certain that we’ll be hiring robot helpers around the house (including serving drinks) and some of us will become robopreneurs, sending out our robots to work. Far fetched? Froyo franchise kiosks (already promoted on radio in the US) serve up robot-prepared and sold frozen yogurt.

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/08/Nao.jpg” thumb_width=”170″ /]For your weekend reading (with coffee and a snack) is a study examining human reactions to a purposely programmed error-ridden NAO humanoid robot versus a behaving NAO in performing interactive tasks. The surprise is that people liked the faulty robot more than the perfect one. The study also gauged the human cues to errant behavior (sidelong gazes, laughter)–cues that could tell the robot it’s in error. To Err Is Robot: How Humans Assess and Act toward an Erroneous Social Robot (Frontiers in Robotics and AI) Second tipped hat to Steve More on SoftBank Robotics’ NAO here.

Robotic exoskeletons are…alive!

It seems like ages–in reality, only two years or so [TTA 19 Dec 15]–that this Editor was writing hopefully about advances in exoskeletons such as ReWalk and Wyss, EKSO plus DARPA research in assisting the mobility of paraplegics and others who need assistance in major movement. And then the news went rather dark, though ReWalk is now in its sixth iteration.

So it is heartening to be able to report that an established healthcare robotics company, Toronto’s Bionik Laboratories, is investing in a joint venture with Boston-based Wistron Corporation, an industrial design and manufacturing company, to further develop the Bionik ARKE lower body exoskeleton. Bionik’s emphasis has been on rehabilitative hospital-to-home upper body robotics to assist patients with regaining mobility. The ARKE appears to be both rehabilitative and assistive for patients in the home. Once developed in the JV, Wistron would be the sole manufacturer. 

According to Crunchbase, Bionik raised $13.1 million in a July 2015 private placement specifically to develop the ARKE (MassDevice). This past May, they raised about $2 million from Hong Kong’s Ginger Capital in a separate JV to sell their robotics into the Chinese market. Bionik partnered with IBM starting last year to develop machine learning to analyze the data generated by the ARKE (FierceBiotech).

The target market for the Bionik/Wistron JV is not in this context a surprise. It is the booming older adult Asian market, where the aging/elderly population is projected to hit 983 million by 2050. Many especially in China and India live in rural areas and aren’t covered by any pension or old-age support (ADB Research). It is not clear to this Editor how expensive lower-body exoskeletons will be supported financially either privately or by government.  Bionik release, FierceBiotech

Behave, Robot! DARPA researchers teaching them some manners.

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/01/Overrun-by-Robots1-183×108.jpg” thumb_width=”150″ /]Weekend Reading While AI is hotly debated and the Drudge Report features daily the eeriest pictures of humanoid robots, the hard work on determining social norms and programming them into robots continues. DARPA-funded researchers at Brown and Tufts Universities are, in their words, working “to understand and formalize human normative systems and how they guide human behavior, so that we can set guidelines for how to design next-generation AI machines that are able to help and interact effectively with humans,” said Reza Ghanadan, DARPA program manager. ‘Normal’ people determine ‘norm violations’ quickly (they must not live in NYC), so to prevent robots from crashing into walls or behaving towards humans in an unethical manner (see Isaac Asimov’s Three Laws of Robotics), the higher levels of robots will eventually have the capacity to learn, represent, activate, and apply a large number of norms to situational behavior. Armed with Science

This directly relates to self-driving cars, which are supposed to solve all sorts of problems from road rage to traffic jams. It turns out that they cannot live up to the breathless hype of Elon Musk, Google, and their ilk, even taking the longer term. Sequencing on roadways? We don’t have the high-accuracy GPS like the Galileo system yet. Rerouting? Eminently hackable and spoofable as WAZE has been. Does it see obstacles, traffic signals, and people clearly? Can it make split-second decisions? Can it anticipate the behavior of other drivers? Can it cope with mechanical failure? No more so, and often less, at present than humans. And self-drivers will be a bonanza for trial lawyers, as added to the list will be car companies and dealers to insurers and owners. While it will give mobility to the older, vision impaired, and disabled, it could also be used to restrict freedom of movement. Why not simply incorporate many of these assistive features into cars, as some have been already? An intelligent analysis–and read the comments (click by comments at bottom to open). Problems and Pitfalls in Self-Driving Cars (American Thinker)

Thinking about a location for your health tech startup? Consider…’virtual’ Estonia!

‘Extreme digital living’ is the norm in the Baltic country of Estonia, which rebuilt itself from the ground up after the formal dissolution of the Soviet Union (and each citizen receiving a distribution of €10) to one of the most advanced online-only countries in the world, far ahead of the US, the UK, and the rest of the EU. Internet access is by law a basic human right in Estonia. Digital signatures are equal in every way to paper signatures, except for marriage and divorce (a nostalgic touch). Everyday living is paperless and programming is taught in early grades. Live in picturesque Tallinn and need a delivery? It may come to your door via Starship robot, founded by one of the former Skype team. (Did you know that former Skypers have funded much of the Estonian tech and investment boom?) They take data security seriously with the Russian Bear growling (and hacking) on the border, so they created a NATO-accredited cyberdefense center in Tallinn and a whole country backup in a Luxembourg ‘data embassy’. Blockchain is a large part of this–and the government is working on using it for mapping the genome data of its 1.3 million citizens and sell it (deidentified) to precision medicine researchers.

So if you are a US, UK, EU, or even Australian-based developer, or already have a small tech company, why is this of interest? Estonia has opened a door for foreigners that is a most attractive one–virtual residency, no matter where you live. Once you’re an e-resident, simply register your company (online of course) and pay a fee of €145. You now can do business in euros–and fully access the EU. Most companies pay monthly administrative and accounting fees in Estonia, providing the country with income. About 1,400 companies have taken advantage of e-residency. It isn’t a tax haven, but if you do have income in Estonia, their corporate taxes are low–20 percent, compared to 19 percent for the UK, 30 percent for Australia, and a shattering 39 percent for the US (at present). Trading Economics And there is that tech and digital-savvy workforce as an additional incentive. Is This Tiny European Nation a Preview of Our Tech Future? (FortuneHat tip to TTA Founder Steve Hards

PwC: your job at risk by robots, AI by 2030?

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/06/robottoy-1.jpg” thumb_width=”150″ /]PwC‘s latest study on the effect of robotics and artificial intelligence on today’s and future workforce is the subject of this BBC Business article focusing on the UK workforce. 30 percent of existing jobs in the UK were potentially at a high risk of automation by the 2030s, compared with 38 percent in the US, 35 percent in Germany and 21 percent in Japan. Most at risk are jobs in manufacturing and retail, but to quote PwC’s page on their multiple studies, robotics and AI may change how we work in a different way, an “augmented and collaborative working model alongside people – what we call the ‘blended workforce’”. Or not less work, but different types of work. But some jobs, like truck (lorry) drivers, would go away or be vastly diminished.

The effect on healthcare? The categories are very broad, but the third category of employment affected is administrative and support services at 37 percent, followed by professional, scientific and technical at 26 percent, and human health and social work at 17 percent. Will it increase productivity and thus salaries, which have languished in the past decade? Will it speed innovation and care in our area? Will it help the older population to be healthy and productive? And the societal effects will roll on, but perhaps not for some. View this wonderful exchange between Jean Harlow and Marie Dressler that closes the 1933 film Dinner at Eight. Hat tip to Guy Dewsbury @dewsbury via Twitter

Technology for Aging in Place, 2017 edition preview

Industry analyst Laurie Orlov previews her annual review of ‘Technology for Aging In Place’ on LinkedIn with six insights into the changes roiling health tech in the US. We’ll start with a favorite point–terminology–and summarize/review each (in bold), not necessarily in order.

“Health Tech” replaces “Digital Health,” begins acknowledging aging. This started well before Brian Dolan’s acknowledgment in Mobihealthnews, as what was ‘digital health’ anyway? This Editor doesn’t relate it to a shift in investment money, more to the 2016 realization by companies and investors that care continuity, meaningful clinician workflow, access to key information, and predictive analytics were a lot more important–and fundable–than trying to figure out how to handle Data Generated by Gadgets.

Niche hardware will fade away – long live software and training. Purpose-built ‘senior tablets’ will likely fade away. The exception will be specialized applications in remote patient monitoring (RPM) for vital signs and in many cases, video, that require adaptation and physical security of standard tablets. These have device connectivity, HIPAA, and FDA (Class I/II) concerns. Other than those, assistive and telehealth apps on tablets, phablets and smartphones with ever-larger screens are enough to manage most needs. An impediment: cost (when will Medicare start assisting with payments for these?), two-year life, dependence on vision, and their occasionally befuddling ways.

Voice-first interfaces will dominate apps and devices. “Instead we will be experimenting with personal assistants or AI-enabled voice first technologies (Siri, Google Home, Amazon Alexa, Cortana) which can act as mini service provider interfaces – find an appointment, a ride, song, a restaurant, a hotel, an airplane seat.” In this Editor’s estimation, a Bridge Too Far for this year, maybe 2018. Considerations are cost, intrusiveness, and accuracy in interpreting voice commands. A strong whiff of the Over-Hyped pervades.

Internet of Things (IoT) replaces sensor-based categories. Sensors are part of IoT, so there’s not much of a distinction here, and this falls into ‘home controls’ which may be out of the box or require custom installation. Adoption again runs into the roadblocks of cost and intrusiveness with older people who may be quite reluctant to take on both. And of course there is the security concern, as many of these devices are insecure, eminently hackable, and has been well documented as such.

Tech-enabled home care pressures traditional homecare providers – or does it? ‘What exactly is tech-enabled care? And what will it be in the future?’ Agreed that there will be a lot of thinking in home care about what $200 million in investment in this area actually means. Is this being driven by compliance, or by uncertainty around what Medicare and state Medicaid will pay for in future?

Robotics and virtual reality will continue — as experiments. Sadly, yes, as widespread adoption means investment, and it’s not there on the senior housing level where there are other issues bubbling, such as real estate and resident safety. There are also liability issues around assistance robotics that have not yet been worked out. Exoskeletons–an assistance method this Editor has wanted to see for several years for older adults and the disabled–seems to be stalled at the functionality/expense/weight level.

Study release TBD

Robot-assisted ‘smart homes’ and AI: the boundary between supportive and intrusive?

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/06/Robot-Belgique-1.png” thumb_width=”200″ /]Something that has been bothersome to Deep Thinkers (and Not Such Deep Thinkers like this Editor) is the almost-forced loss of control inherent in discussion of AI-powered technology. There is a elitist Wagging of Fingers that generally accompanies the Inevitable Questions and Qualms.

  • If you don’t think 100 percent self-driving cars are an Unalloyed Wonder, like Elon Musk and Google tells you, you’re a Luddite
  • If you have concerns about nanny tech or smart homes which can spy on you, you’re paranoid
  • If you are concerned that robots will take the ‘social’ out of ‘social care’, likely replace human carers for people, or lose your neighbor their job, you are not with the program

I have likely led with the reason why: loss of control. Control does not motivate just Control Freaks. Think about the decisions you like versus the ones you don’t. Think about how helpless you felt as a child or teenager when big decisions were made without any of your input. It goes that deep.

In the smart home, robotic/AI world then, who has the control? Someone unknown, faceless, well meaning but with their own rationale? (Yes, those metrics–quality, cost, savings) Recall ‘Uninvited Guests’, the video which demonstrated that Dad Ain’t Gonna Take Nannying and is good at sabotage.

Let’s stop and consider: what are we doing? Where are we going? What fills the need for assistance and care, yet retains that person’s human autonomy and that old term…dignity? Maybe they might even like it? For your consideration:

How a robot could be grandma’s new carer (plastic dogs to the contrary in The Guardian)

AI Is Not out to Get Us (Scientific American)

Hat tip on both to reader Malcolm Fisk, Senior Research Fellow (CCSR) at De Montfort University via LinkedIn

Touch and feeling through a bionic prosthetic arm (DARPA-Univ. Pittsburgh)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/11/bionic-arm.jpg” thumb_width=”200″ /]A robotic arm with a neural interface that allows the user to experience touch has been developed by the University of Pittsburgh and University of Pittsburgh Medical Center, funded by the Defense Advanced Research Projects Agency (DARPA).  The Revolutionizing Prosthetics program since 2006 has been developing advanced upper-limb prosthetics. Their first was the Gen-3 Arm System by DEKA Integrated Solutions Corporation, submitted for 510(k) in 2012. The subject for the test of the touch interface, Nathan, has been a quadriplegic from the chest down since 2004. He permitted four microelectrode arrays, each about half the size of a shirt button, to be placed in his brain: two in the motor cortex and two in the sensory cortex regions that correspond to feeling in his fingers and palm. Wires run from the arrays to the robotic arm, which has torque sensors that detect when pressure is applied to its fingers. These physical “sensations” are converted into electrical signals back to the arrays in Nathan’s brain so that he has the sensation of feeling and touch.  The sensation of touch in the bionic arm is near 100 percent natural and accurate. This research has great potential both for prosthetics and for other neurological conditions. Armed With Science.  Video