LoJacking Grandma and “Reality Mining,” or “Daddy, What was Anonymity?”
photo by mrsmartino via flickr
Mark Heftler, a geriatric care manager who is slated to begin study at Seton Hall Law in the Fall, has written an interesting article on RFID (Radio Frequency Identification) and its potential usage as a means of early diagnosis of dementia among the elderly. Researchers at the University of South Florida have developed and tested an RFID technology which assesses the walking patterns of those which it monitors.
By monitoring the movements of the elderly within geriatric facilities, “the researchers hope to be able to diagnose the onset Alzheimer’s in their patients. Sudden veers, long pauses, and a tendency to wander are all indicators of dementia.”
As MIT’s Technology Review notes, “Drugs that are currently available can only slow the progression of related diseases, so the earlier dementia is caught, the better a patient’s treatment will be.”
Technology Review also notes, “In particular, dementia increases the risk of injury caused by a fall… ‘That’s a huge problem for assisted-living facilities,’” said William Kearns, an assistant professor who researches aging and mental health at USF.
Not Just Grandma
Although one can readily see the positive cost/benefit and quality of life implications of warding off the falls of the elderly, as Frank Pasquale recently noted on both this blog and Concurring Opinions, the proliferation of “personal” electronic data is not without its danger.
The Technology Review article provides a link to another article which points out that RFID technology is also being harnessed to gather social networking information through what is referred to as “reality mining,”
“…a field that Tanzeem Choudhury pioneered as a PhD student at the MIT Media Lab. Working at Intel after graduation, she created a pager-size sensor pack–loaded with software plus microphones, accelerometers, and other data-gathering devices–to collect and analyze data about human interactions and activity. For instance, by processing verbal utterances, she can identify the most influential people in a social network.
Now an assistant professor of computer science at Dartmouth, Choudhury is conducting experiments with the sensor-laden iPhone. Within a few years, she says, simple versions of her software could be available for cell phones.”
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It was my pleasure to post it, I’m glad you were able to come across it and continue the discussion of it! Privacy concerns hadn’t even crossed my mind when I referenced the study - working at our Geriatric Care Management practice has taught me to focus more on the providing of hands-on care to our clients. The fears that we have are more in regard to the hands-off nature that technology fosters. When the elderly have devices installed in their homes that allow communication to their primary care physicians, they lose out on that key interaction they were previously accustomed to. Besides that, they’ll be placing their trust in the ability of a doctor to diagnose or catch a medical issue from their office across the town, or across the state. The pros and cons of the technological times we live in become more and more convoluted with each passing day.
Our ability to monitor health care states electronically is not news to anyone who has been hooked up to a halter monitor or other ‘at a distance’ diagnositic or treatment modalities. Many of us have installed GPS monitors in our cars or we carry them with them as we back country ski, sail oceans, or just take our daily adventures. The questions of who uses these devices and why remains central to our conclusions of wether we use them or not. Some level of understanding and consent is inherent to the decision making. Will we use these monitors on patients, elders in some stage of possible dementia, who may not necessarily be able to fully consent, due to their congitive capabilities, is an important consideration and a great deal more tricky. The fact that these technologies are being used for information leading to a diagnosis, rather than a diagnosis itself (movement patterns of a body in space, as opposed to the insulin levels in blood or the number of heart beats per moment, for example). The question that continues to arise, simply because we have put our focus more on the minutia of the technology rather than the biomedical ethics of the whole ball of yarn, is ‘how will we ensure that our use of these developing technologies are used for the benefit of the patient, rather than the share holders of the insurance companies or other entities with differing secondary gains?’ Overt discussions and agreement that these monitors will generate clinical information used ‘for’ the patient and not ‘at’ the patient is the critical next step, and this must be done in public, in a forum or series of conversations between the public, the physician teams, the insurers, and the other consumers, all of whom have an interest in this going well, but many of whom have a more specific interest in using it for reasons other than direct clinical benefit. In case of wiring Grandma, earliest possible diagnosis of dementia would open doors for medical treatment, environmental safety options and community support. This is a no-brainer. To forgo the use of this technology because it can be applied otherwise is capricious. Having the public discussion of the use of these technologies is essential.
You both raise interesting points. The danger inherent in technology replacing “the laying of hands,” if you will, and the danger in failing to heed the distinction between using technology derived data “for,” as opposed to “at,” patients.
As you are both clinicians, I defer to your assessments of the practical aspects–and, in fact, agree. “Wiring Grandma” in an attempt to prevent damaging and costly falls does seem to be a “no brainer” in the sense that forewarned is forearmed–and we certainly do not want the technology to replace human assessment, but function as an aid to such.
The problem seems to me to lie in the proverbial “slippery slope” and who gets to define what the difference between “for” and “at” a patient is. The RFID technology itself, like a hammer, is neutral. As a hammer may be used to both drive nails to build or fix houses “for” people, or, as a deadly weapon when used “at” people. So it seems (though perhaps somewhat less dramatically) with RFID technology.
Although it is the i-Phone usage for determining “alpha” social network persons, etc… that gives rise to my greatest pause and fear, this who determines “for” or “at” aspect of the RFID medical monitoring also gives rise to some hesitation.
When we think in terms of stopping falls, it is easy (grandma doesn’t want to fall, we, through Medicaid, don’t want to have to pay for the results of Grandma’s fall). But when we start to think in terms of behavior modification and choice it becomes more difficult: i.e., We don’t want Grandpa to smoke– as we don’t want to have to pay for the medical results of Grandpa’s smoking–or, we just want Grandpa to live longer.
We then would be acting (in our minds) “for” Grandpa, but if Grandpa simply wants to smoke– has made the cost/benefit analysis and has decided that he is willing to forgo additional time spent treading the earth in favor of the enjoyment he receives from pursuing his nicotine addiction, then from an individual rights perspective we are directing what we consider “for,” “at” Grandpa. I use smoking here, but it could just as easily be cheeseburgers and hot fudge sundaes. The question is still the same: who determines– in a social based system of insurance– what constitutes “at” and what constitutes “for.” Throw in a duty to shareholders in profit based systems, and the “for”/”at” takes on a different cast.
In Self Reliance, Emerson states: “society is a joint-stock company in which the members agree, for the better securing of his bread to each shareholder, to surrender the liberty and culture of the eater.”
I am not prepared to surrender my liberty– either through a thousand small cuts or one fell swoop– to secure cost efficient health insurance.
Ah grasshopper, you missed an important point. Due to the fact that your and my liberties have already been suspended, we can move beyond that. In this case we can determine that the technology of monitoring is 1) requested and/or consented to upon by the patient or their designee 2) is seen as a short term diagnostic tool with the only implications being collection of health specific data which the physician/health care provider and patient apply to their mutually agreed upon treatment. Sometimes these treatments will result in insurance companies paying for them, other times they may yield information that suggests environmental or care level changes. Good care does not always require insurance payment or involvment of an insurance company 3) the technology reports information held under HIPPA. When the intent of these technologies is primarily diagnostic, then a diagnosis is made and treatment is offered. Using these technologies as a behavior modifier is more in line with the little black ankle bracelets we know from the parole system and that is a different conversation all together. Diagnosis is specific. Behavior modification and monitoring is less so. When we look at the specific health care applications we must continue to look at and involve the biomedical ethics community to guide the application and use of any data.