Using Specialized Networks in Sociable Robots to Protect Patient Information

Amanda Jaworski Case Western Reserve University Cleveland, Ohio 44106

Abstract The goal of this proposed research is to find whether or not the use of Body Area Networks (BANs) would be feasible for use in the Philos sociable robotic system for gathering medical information from patients. The numbers of individuals requiring constant medical care and monitoring have been increasing in recent years, with no signs of a plateau on the horizon. To handle the increased need for medical personal to monitor and care for these individuals, personalizable, social robotics are being created. One of these robots, Philos, has been created in the Case Western Reserve Distributed Intelligence and Robotics laboratory. This proposal offers the suggestion of Philos using BAN connected devices to gather health information from the patients utilizing the robots service. Included in the proposal are relevant background information, a plan and schedule for the research, and short statements addressing the qualifications and abilities of the researcher and anticipated PI involvement for the research work.

Table of Contents 1. Project Description 3 1.1 1.2 1.3 Introduction .. 3 Problem Description . 3 Summary of Proposed Research . 4

2. Research Plan and schedule .. 5 2.1 2.2 Hypothesis .. 5 Specific Project Aim .. 5 2.2.1. Purpose .. 5 2.2.2. Specific Research Description and Methods .. 6 2.3 2.4 Schedule . 8 Budget .... 8

3. Researcher Qualifications ... 8 4. PI Involvement . 9 5. Bibliography .. 10

Using Specialized Networks in Sociable Robots to Protect Patient Information

1. 1.1

Project Description Introduction

Individuals who require frequent or constant health monitoring dont have many options to receive the care that they need they currently can either reside in a facility that offers constant care and observation, or can hire someone to provide those services to them in their own residence. To help those individuals retain their independence while still receiving the care they need, a sociable robot, Philos, is being created. Philos has the ability to be personalized for each individuals specific needs. The main premise of the robot is that, via wearable wireless sensors and facial detection, it can monitor health information and interact with individuals. Current progress Philos is being made in its ability to show expressions via a computercontrolled face facsimile, its ability to recognize an individual by their facial features and recall information about them, and in its ability to exhibit behavioral characteristics. The authors proposed research will develop the functional work the robot will do; specifically, it will be concerned with how Philos collects information and biologic readings from the patient (such as blood pressure, and heart rate information), the secure storage and analysis of health information over time for each of the possible multiple users, and what actions are possible for Philos to carry out following a health event. In the following, the identification of why Philos is needed, what the system can be capable of, and the authors proposal are covered more completely.

1.2

Problem Description

Patient health monitoring is becoming a necessity more often now than ever before. To help fulfill the requirements for health monitoring and individual independence, we can look to the robotics field for a solution. By using robotics to assist in the monitoring of health data, patients can have more independence while their vital information is still being tracked. Currently, we are experiencing a higher prevalence of chronic illnesses among our population in addition to those needing constant care due to older age, likely due to an increased expected lifespan and more individuals seeking and receiving medical help [1]. With this rise in individuals being diagnosed with chronic or long-term illnesses, there has also been a rise in the need for those individuals to receive constant medical monitoring to protect them from suffering further health deterioration. [2] With the classic way of receiving this observational care, patients are required to report to an outpatient location, to have nurses or other medically trained individuals with them for the majority of the time, or are required to stay in a care facility. For some individuals, this method works fine, but many desire more personalized care care that can allow them to retain their independence and live a more normal life, outside of care facilities and without requiring nurses who, despite their best efforts, may miss small anomalies that could have major repercussions due to stress or tiredness. This is where robotics can, and to an extent is already beginning to, come into play. Progress has already been made for remote tracking of medical information via a system called MORF, which uses medical sensors to gather biologic signals from the patient, such as blood pressure, heart rate and temperature. The system then autonomously analyzes that information to determine if the patients condition is worsening, and can execute some sequence of events when certain conditions are met [2]. Using Specialized Networks in Sociable Robots to Protect Patient Information 3

The MORF system capitalizes on mobile monitoring methods [2] which allows patient observation to be conducted without causing major inconveniences to those individuals. They are able to go about their normal, daily lives while being kept under medical watch to ensure that their conditions do not worsen. A very good example of the use of this system would be a recent heart attack patient, who can now be sent home to recover in the comfort of their own home, surrounded by their family and friends, while still having their vitals monitored by their doctor. If their vitals are different from what is anticipated for a healthy, recovering patient, the system can issue an alert and action sequence to send the help required to that individual. [2] In addition to constant monitoring of health signals, there may also be a role for robotassistance in the regular health screenings and social therapy sessions of those with a mental illness. The mentally ill have are believed to have a higher risk of obesity, hypertension, high cholesterol and glucose, than those without mental illness [3] and so those levels in patients suffering from mental illness should be better tracked [4]. This tracking could range from selftesting and screening, up to what is close to the aforementioned constant care [5]. The social aspect of robots conducting medical work is the basis of the work that has already been done on the project of sociable robots, led by Professor Kiju Lee. Following the findings that addressing the patient personally heighten their perceptiveness of information [6], and that the companionship and social benefits related to interaction with the robot [7], the Sociable Robot project is already beginning to take shape. The current progress being made with the project lie within the physical motion, facial detection, and behavioral algorithms segments of the robot, called Philos [8]. With the ability to move, and show expressions through a cartoon-like, but recognizable face; the ability to track and recognize the faces of individuals it has interacted with before; and a framework in place for behavioral characteristics and a sort of personality [8], Philos is on his way to becoming an excellent example of a robot to be used for companionship and social therapy sessions.

1.3

Summary of Proposed Research

The proposed research for the Philos project is in regards to the robots ability to gather, and act on medical information and readings from patients. The plan is to research the feasibility and possible success of implementing wireless health information readers with the Philos system using a body area network (BAN) that Philos can connect to when near patients requiring health monitoring. BANs are used currently with low-power devices, used in close proximity to each other (usually around the body), which make their use perfect in the medical field [9], such as for Philos purpose. Using the BANs, Philos will be able to connect to patients wearable health monitors, and receiving information regarding their heart rate, blood pressure, glucose levels, and other information. That information can then be stored, compared to past information from the patient, analyzed to determine if there is an element to be concerned about, and then an appropriate action can be decided on and acted out, depending on the severity of situation. To live up to his potential as a true medical companion, implementable for use in numerous situations [6], Philos needs to have his own system for receiving, parsing, and analyzing medical information, that can be customized to fulfill the needs of those who will be using the system. The use of BANs appear to be the best implementation of this, and, given the opportunity via approval of the research proposal, the aspects of the software required to gather, analyze, and securely store patient information can be more fully researched, planned, and ultimately created.

Using Specialized Networks in Sociable Robots to Protect Patient Information

2. 2.1

Research Plan and Schedule Hypothesis

It follows that with more individuals needing the type of monitoring or therapy that Philos can provide, more and more information regarding a patients health will need to be gathered securely and transferred to the necessary databases, preferably by wireless means to save the patient from being constrained or inconvenienced. To control this data transferring, new methods to keep the information secure are required. The premise of the proposed research is to find the best way for the Philos system to quickly and securely connect to a recognized patients health monitoring devices and gather the data from them. Once this is done, Philos should then be able to store and analyze the data securely, and decide on an action based on that data, either immediately through the BAN involving a device connected to the patient for medicine delivery, or through a larger network or other communication method to contact a doctor or emergency services. While all aspects of this data collection and analysis process are important, and will need to be completely developed before Philos is put into full use, the main emphasis of the research being proposed herein focuses mainly on the research and feasibility tests into the use of BANs to collect health information from the patient securely, to reduce the risk of patient data being lost or accessed maliciously while being transmitted. Because BANs are very small wireless networks that do not require a significant amount of power to function, they appear to be ideal for use in the medical field, especially for the gathering of patient health information, such as blood pressure, glucose, oxygen, and respiratory levels. These readings are among the health levels and statistics that must be monitored for patients that are receiving constant care, such as those that would be utilizing Philos as a medical device. As such, it is worth looking into the feasibility of Philos using BAN connected devices to gather information about a patient. With Philos being an investment himself, the use of these devices should be able to give Philos the functionality required of him while keeping the costs for that aspect of the system.

2.2

Specific Project Aim 2.2.1. Purpose

Going into the future, with more chronic illnesses being diagnosed and a larger elderly population, the need for constant care and health monitoring is sure to rise [1]. Following this reasoning, we can come to the conclusion that there will be a corresponding increase in the need for individuals to conduct this continuous care for those patients requiring it. The question therein, is how we deal with that increased need. One option is to try to meet it with increased medical staffing. This, however, can be shown to not be the most efficient or the best in terms of accuracy and patient well-being in the long run. The possibilities for this option not being practicable range from lack of qualified medical staff to conduct the observations and monitoring, to overworked or inattentive medical staff missing signs of a dangerous health issue, especially in the cases concerning patients requiring constant care. Another option, which appears to solve the downfalls of the human-only care, is with the use of robotic systems. Specifically, the work being done and proposed end product for the Using Specialized Networks in Sociable Robots to Protect Patient Information 5

Philos system appear to fit the requirement for use in continuous care situations. This research proposal is written to request the ability to assist in the development of the Philos system, to make it into a product that can be used in such situations as described above. To enable the Philos system to live up to its potential, it needs to have a comprehensive system to gather, store, and analyze health information from the patients that it is monitoring. Without this system in place, Philos will be unable to function as he was designed to. Work on the storage system and network connections should not be pushed until last, as it is a significant portion of what the Philos system will have to use in everyday use once it is in practice. Getting a head start while Philos other functions are still being developed will allow for proper and thorough testing to guarantee the patients privacy. Without the extended amount of time for research into different systems for the information gathering to determine the best option, and subsequent testing of the system ultimately chosen, there is a risk for errors or bugs to arise, resulting in defective or non-functioning information gathering and analysis. To ensure the best system possible, with the lowest risk for errors, work must be started on the system as soon as possible.

2.2.2. Specific Research Description and Methods The proposed research will look into the feasibility and options for implementation of BAN networks in the Philos system. On paper, BANs appear to be a good prospective option for the Philos system to use to gather health information from patients. They are small, mobile networks, designed to be used with low-power devices that are either close to or actually physically on the body [9]. They are lauded as being ideal for use in the medical industry, especially for the type of data collection involved with the Philos system. Since the BANs are most commonly used in conjunction with low-power devices, they are usually used without todays more conventional security measures, such as public key cryptography [9]. As such, the information transferred via the BANs cannot be considered secure or protected. To circumvent this security issue, anonymous identity management has been proposed [9], in which the medical data is sent without corresponding patient-specific identification data. Once delivered to the hospital or medical center home-base, the information must then be matched to the patient from whom the information was collected from, so that it can be stored and analyzed. Agrafioti et. al presented a method of matching this data to patients via ECG readings. The system was shown to be effective in identifying healthy individuals. However, the research brings proposes no data or solutions for patient recognition in situations where the patients biometric readings are distorted due to a medical emergency. Philos facial, and possible vocal, recognition would eliminate this issue. Using the same anonymous information transfer, Philos would be able to gather health information from its users without the need to incorporate any patient-identifying data included. Since the data will be collected while Philos is close enough to connect to the patients personal BAN, and he will presumably be interacting with the patient at the same time, Philos recognition of the patient would allow him to automatically save the patients health data to his on-board data storage. Once the data is saved, Philos would be able to analyze the data on-board and decide whether there is a medical problem or not. If a problem is found with the patients information, Philos could then re-engage with the patients BAN to take further readings, administer medication if the patient is equipped with those devices, or connect to an exterior network to contact appropriate individuals with notification of the patients condition and a request for further

Using Specialized Networks in Sociable Robots to Protect Patient Information

assistance. The requests could range from scheduling an appointment with the patients doctor to contacting emergency services, depending on the severity of the patients condition. The feasibility of using the BAN with Philos will be conducted as follows: 1. First, an economic feasibility test will be conducted. With access to Philos specifications and what the expectations are for his overall cost to operate, a basic monetary feasibility review will be conducted. In this feasibility, the cost of the supplementary health reading devices, the BAN network device, and the ultimate cost of the program that Philos will use to store data will be taken into account. The purpose of this feasibility review is to determine if the use of BAN networks in conjunction with specialized devices with the Philos system will run at a significantly higher cost than if the data collection was conducted with more general, non-Body Area Network specific devices. 2. The code for the program Philos would use to save and analyze the data will be compiled. It can either be written from scratch, or purchased and customized from a software vendor if an appropriate customizable option can be found. 3. A BAN network and connectable wireless medical readers must be purchased for testing use. Also, Philos will need to be configured to connect to the BAN whenever he is close enough to the patient to receive the signal. Also included in the final feasibility assessment will be the distance that Philos must be in relation to the patient and how stable the signal from the BAN will be. 4. A set of detailed simulation guidelines and procedure descriptions will be constructed. These are required to ensure that each simulation will be identical, leading to more normalized results throughout the testing process, allowing the testers to more easily identify the direct cause of any glitches or problems in the simulations. 5. Philos will be put through a simulated patient information-gathering exercise, where he will interact with a pseudo patient, identify them via his recognition abilities, and then will collect health readings from the BAN monitors on the patients person. In the beginning of this phase of the research, a trial-and-error mindset may need to be adapted to find the best way to test the gathering of information by Philos over the BAN and its subsequent storage in the on-board patient directory. 6. Following collection of the data, Philos will then be manually made to recognize a medical event and attempt a solution via the BAN. This step will enable the testing of Philos analysis and solution selection abilities as well the ability to send information back to the patients devices, over the BAN, for immediate medical assistance. 7. Following the simulation, information regarding the level of success of the attempt will be recorded, and modifications will be made to solve any issues that arose during the simulation. Repetition from step 4 will be conducted as necessary. Following this testing cycle, a final assessment of the feasibility of the use of BANs will be compiled. This assessment will take into account the economic feasibility report from the beginning of the research, the problems that arose through the testing portion of the research and whether or not they were solved through the troubleshooting and modification stage of the Using Specialized Networks in Sociable Robots to Protect Patient Information 7

cycle, and if the data was able to be retrieved, stored completely in the correct place, and whether or not the forced action sent to over the BAN was successfully enacted. The final assessment of feasibility for the use of BANs in the Philos system will then provide an opinion on whether the use of BAN networks in the Philos system is a functional, achievable option, and whether or not its implementation would be worth the increased cost to furnish the system with the required additional hardware.

2.3

Schedule

The research into the feasibility for the use of BANs with Philos will take approximately one to two semesters. The following Gantt chart provides a visual depiction of the processes involved. Task Economic feasibility study Program customization Purchase of BAN devices Creation of simulation guidelines Situational simulations Troubleshooting and modifications Final evaluation of simulation data Assessment of feasibility for use of BANs Sep Oct Nov Dec Jan Feb Mar Apr May

2.4

Budget

A specific budget, based on an amount given for further proposal consideration, will be made available upon request. Possible software purchases, medical reading devices, and connectivity devices will be included in the budget.

3.

Researcher Qualifications As a binary, computer engineering student at Case Western Reserve, with a second bachelors degree pending in Management Information Systems from Notre Dame College, Amanda Jaworski has become well versed in types of networks, security protocols and security measures that must be taken with the Philos system. She has become proficient in the design of systems such as the ones that would be required in the Philos system though the classes required for her majors. While she is not involved in the medical field in any of her current endeavors, she sees that Philos has an incredible opportunity to positively affect the lives of numerous individuals. Her past coursework and course related projects have given her the knowledge that she believes can be applied to the Philos system. As she knows the basic concepts of networks, a short, more in-depth alignment to the specifics of Body Area Networks will be required, but should not impede any work from being started in the economic feasibility testing. Since she has never worked in a lab, or on robotics before, she will need to be taught the proper lab and documentation protocols.

Using Specialized Networks in Sociable Robots to Protect Patient Information

4.

PI involvement To complete the research involved in this project, access to the Philos system to install, upgrade, and modify software will be required. A suitable option for the patient simulation must also be provided, either through the use of a willingly participating individual interacting with Philos or via a forced simulation through manually forcing Philos to recognize an individual and accepting data by way of the BAN that is fed through a manual simulation station.

Using Specialized Networks in Sociable Robots to Protect Patient Information

5.

Bibliography [1] D. L. Costa, Causes of Improving Health and Longevity at Older Ages: A Review of the Explanations, Genus, vol. 61, no. 1, pp. 2138, 2005. [2] L. Docksteader, MORF: A Mobile Health-Monitoring Platform, IT Professional, vol. 9, no.3, pp. 1825, 2010. [3] F. Millar, Better monitoring for better health, Australian Nursing J., vol. 20, no. 2, Aug. 2012. [4] D. Robson and R. Gray, Serious mental illness and physical health problems: a discussion paper, Int. J. of Nursing Studies, vol. 44, no. 3, pp. 457466, Mar. 2007. [5] G. Tosh et al., Physical health care monitoring for people with serious mental illness, The Cochrane Database of Systematic Reviews, vol. 1, no. 1, 2014. [6] D. Rhode, Personal(ized) health monitoring, personalization, and personality, J. of Technology in Human Services, vol. 29, no. 2, pp. 83100, Apr. 2011. [7] K. Lee et al, Towards Social-Therapeutic Robots: How to Strategically Implement a Robot for Social Group Therapy?, IEEE Int. Symp. on Computational Intell. in Robotics and Automation, Dec. 2009. [8] K. Lee. (2013). Distributed Intell. and Robotics Lab: Sociable Robots [Online]. Available: http://www.case.edu Directory: mae/robotics [9] F. Agrafioti et al., Medical Biometrics in Mobile Health Monitoring, Security and Commun. Networks, vol. 4, no. 5, pp. 525539, May 2011.

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