As smart healthcare applications become more pervasive through the use of smart technologies, the Internet of Things, and data analytics, a critical issue is beginning to emerge.  The introduction of new technologies to healthcare has many benefits, but it can also widen the gap between patient and caregiver. However, although healthcare is becoming increasingly technology-based, it doesn’t have to be impersonal. Nancy Laplante, an associate professor of nursing at Widener University, and Phillip A. Laplante, a professor of software engineering at the Pennsylvania State University, think that “caring” is a very important system attribute – not just for IoT or other healthcare systems. In a recent article in IEEE Software, they argue that “caring” should be a quantifiable metric in many smart systems. “Caring is an important quality to achieve in other kinds of systems as well, such as companion robots, academic advising systems, pet care systems, and many others.” Below, Laplante and Laplante provide their insights on how to reduce the space between smart healthcare and true caring.

What is the most difficult aspect of defining “caring” inside healthcare? Why is it important to do so?

Caring is subjective, and can hold different meanings. Patients and their families want to know that what is being done to treat them is the most appropriate treatment, and they want someone involved who has their best interests at heart. Caring is sometimes discussed along with trust, and nurses regularly are ranked #1 for trust in Gallup polls. Nurses and other health care providers often meet patients at the most stressful times in their lives – when they are vulnerable. Patients need someone who cares about them as a human being – not just a statistic.

How do we reduce the space between IoT devices and true caring?

The first step in answering this question is defining a way to measure that gap. Our research is taking us in this direction. Once we can find acceptable ways to measure technological caring,  we can build testing oracles to assess how “caring” systems are. Then we can find ways to help define certain non-functional requirements that are related to caring so as to define more “caring” systems. Finally, we hope to link these caring requirements to architectural elements in systems (e.g. tactics, patterns), so that we can give guidance to systems designers on how to build more caring systems. We also believe that in doing this research there is a need for interprofessional collaboration – that is – healthcare providers and engineers. These systems cannot be built without input from all stakeholders.

How do we ensure security — in terms of both patient privacy and the patient’s perception of his/her own security — when using remote healthcare technologies?

This is another important question that is, fortunately, being studied by a lot of people and organizations. Of course, compliance with applicable privacy laws (such as HIPAA in the US), is an important part of this. Patients also need to trust the technology and understand the benefits to them. Support systems and education (of both patients and caregivers) on how to use these devices is critical.

Is caring subjective? How do we account for this? Does this differ globally, and, if so, what implications are there in standardizing or quantifying this across cultures? Can there be a global standard?

Caring is subjective and culture can influence one’s perception of it. A simple example is touch. In some cultures, for example in the US, holding a patient’s hand could emote caring, while in some cultures this would be inappropriate or offensive. A global standard would be challenging to determine; however ethics are a global theme in health care. Part of caring is treating others with respect and dignity, and adhering to a professional code of ethics. Caring is part of the human connection that health care providers have with patients – and any technology used must meet high standards.

What are the biggest benefits of a smart healthcare system? The biggest challenges?

The anticipated benefits include improved patient outcomes (e.g. faster time to recovery, higher rates of recovery/survival, improved patient experience), better utilization of resources (equipment, supplies and people) and reduced costs. The challenges include technological ones (e.g. electromagnetic interference inside the hospital), insuring privacy and security, and ensuring that an authentic presence of human interaction is preserved.

The article says, in order for smart healthcare systems to work, “[healthcare practitioners] must value and integrate these technologies.” From your experience, is there resistance to this? If so, how can that resistance be combatted for benefit of both practitioner and patient?

There can be resistance to technology as the concern, among nurses in particular, is that it can take you away from direct patient contact. The key is the interprofessional collaboration, so that systems are designed with input from all parties, especially those who will use them. Early development of electronic health records was met with resistance, for example, as physicians were consulted as to screens and information needed, while it was the nurses and support staff who would interact with them. Frequently what they needed was not there, and the systems were not user friendly.

What are examples of technologies that could most revolutionize how healthcare is delivered?

Telemedicine is already being used (or could be used) to deliver high quality care to remote locations, in theatres of war, and in space travel. Smart technologies, enabled by the IoT can enable more autonomous healthcare systems, e.g. in home care. It is important to think outside of acute care for technologies that work in communities. Aging populations also present new challenges for delivery of care and monitoring. As older adults desire to age in place in their homes, health care needs to come to them. Remote monitoring could help assure that an older adult is safe and there are no new health concerns.

How can a global organization like the IEEE influence the reduction of space between IoT devices and true caring?

The concept of caring – baked into technology – is a new one. IEEE, as the leading and largest technological professional society, can lead the way in promoting the concept of caring and in disseminating research and practice results. We hope to see conference tracks, and special issues of publications devoted to caring systems.