Roschelle (Shelly) Fritz usually draws her research conclusions from qualitative rather than quantitative data. That is, instead of building a case with numbers, she typically reads a narrative or asks questions to detect patterns and derive meaning. A recent grant awarded to Fritz and two Washington State University colleagues gives her a new challenge: qualitative analysis of quantitative data. Now, instead of looking for meaning in what someone says, she remarked, “I am looking for meaning in data regarding how someone moved.”
That someone would be an older adult living independently in a “smart home,” with sensors recording the person’s movement. Fritz’s job is to interpret that data using a clinical lens. The project seeks to determine whether technology can help people stay in their homes longer.
To investigate how smart-home technology can monitor the health and safety of older adults from afar, the project received a five-year, $1.77 million grant from the National Institute of Nursing Research—part of the National Institutes of Health. Its title: “A Clinician-in-the-Loop Smart Home to Support Health Monitoring and Intervention for Chronic Conditions.”
The three researchers, all female, have complementary perspectives. Diane Cook, professor in the School of Electrical Engineering & Computer Science, provides the technology expertise. Maureen Schmitter-Edgecombe, a professor of psychology, is exploring whether health interventions affect cognitive health. Fritz, an assistant professor of nursing at WSU Vancouver, provides the clinical judgment.
THE MEANING OF BEHAVIORAL CHANGE
For the study, multiple sensors are placed strategically in five homes in retirement communities in Spokane. (The research may expand to other locations during the grant period.) The sensors detect motion and record the residents’ data moment by moment. The clinician analyzes the data to determine their routines, such as getting out of bed to go to the bathroom or the kitchen at night. When the clinician flags a particular pattern as important, the engineer creates an algorithm to trigger an automatic alert to caregivers in the absence of that motion. If the change is significant, it may indicate the need for a “health intervention,” such as a visit or call.
Fritz is well suited to the task. She has been a nurse for 25 years, with experience in emergency rooms, public health, hospitals and employee health, as well as teaching.
The sensor technology adds something lacking in previous research, where people tell the researcher about their experience. That something is accuracy. “Sensor data has more credibility than when someone self-reports,” Fritz said. While someone might neglect to tell a caregiver about a recent slip, for example, the behavior change cannot be ignored by the smart home.
During the grant period, the research will focus on developing the machine learning piece of the puzzle. Taking into account the person’s health condition—such as a chronic disease—Fritz will tell the engineers what she believes she is seeing in the data, and they will develop an algorithm and alerts when motion indicating a change in health state is noted.
“We are not doing diagnostics,” Fritz said, “but training an intelligent machine to understand what a change in health state looks like, much as a home health nurse would assess that.” Essentially, they are training the machine to learn about the individual’s health and behavior.
BRIDGING TECHNOLOGY AND HUMAN EXPERIENCE
The research also seeks to inform engineers’ ability to communicate effectively with clinicians, Fritz said. “The only way the data can impact clinical decision making is if we are provided information we can understand. How do you take big data like this and present it to a healthcare provider in a way that’s meaningful and relevant to their work—which medicines or treatments to prescribe?”
Students will be working on the project along with the researchers. Cook’s and Schmitter-Edgecombe’s student engineers and psychologists are developing visual analytics based on the data and working with Fritz’s nursing informatics students to determine what visuals nurses like best. “Classes will go back and forth doing that,” Fritz said. “It’s very fun and innovative, multidisciplinary teaching.”The project’s long-term goals address today’s major health concerns, from growth of the aging population to the shortage of caregivers to the cost of healthcare. One big question: Can technology make it possible to extend the reach of caregivers and nurses? Perhaps.
Cost is another matter. “It’s a very simple sensor technology,” Fritz said. “What’s expensive is the infrastructure and brains behind the algorithm.”
Smart homes are not new. For example, Cook has developed a “Smart Home in a Box,” currently deployed in more than 110 homes around the world. Bringing in a clinician to study the data, along with automating health monitoring, assessment and evaluation of the intervention impact, is an important new step in determining whether the system can help individuals manage chronic health conditions.
“We are nowhere near a market-ready product,” Fritz said. “This is very futuristic.”