“Bob, I’m very sorry to share that last month, you most likely gave 4 patients MRSA infections and didn’t appear to have washed your hands prior to having direct contact with each of them. The data for you and all other providers in this organization comes from a continuous, indoor location tracking system. It also knows exactly where the wash sinks and hand sanitizers are. You didn’t appear to have stopped at any of them. All other providers did, and other known infection causes have been evaluated based on real time data and excluded.”
I was reminded during a recent presentation by a venture capitalist that, when considering any new idea, the first questions should be, “who is bringing the idea, and are they a friend of foe?” If it’s a great idea coming from a serially successful, smart friend, then you definitely keep listening and assume an inviting posture. Otherwise, you need to be far more cautious. That’s the framework I’d like to apply to the newly emerging technology of Indoor GPS.
Navigational GPS has generally made driving through unfamiliar areas a reliable process. In recent years, we’ve become relatively spoiled, in that our smartphones can tell us where we are, where we’re going, arrival time, and alert us dynamically to options that may be a few minutes faster based on real time traffic updates. In addition to supporting navigation to drivers, pedestrians are increasingly using GPS to find their way while walking, especially in cities.
Beyond navigation, there are location-based services (LBS) supporting other activities, including giving us selection options in any application that take into account where we are. For example, the availability and wait time for taxis is now available from several services such as Uber. Like oxygen, we’re coming to the point where we only notice GPS when it’s gone.
So let’s fast forward. We are now entering an era where a variety of technologies are making it possible to do GPS indoors using ubiquitous devices such as smartphones with Bluetooth. They make it possible to extend navigation inside structures like buildings, and less obviously, to specific aisles, shelves, etc., within those buildings. In my HIMSS 2015 blog post, I described a scenario of finding the location of a specific type and brand of lettuce in the supermarket, and getting directions to within an inch of that lettuce. This technology, with its negligible transaction costs, is now a mainstream capability.
For consumers, exercisers, dieters, or other diverse groups, this functionality is being adapted to provide significant new insights beyond navigation. We are now collecting miles ran or walked, steps taken, stairs climbed. We can and are getting this information summarized for us, with no additional effort on our part, by the hour, day, week or month. Your step data can be collected by your smartphone. This data can readily be combined with other information, including heart rate and weight, in a minimally intrusive way. Increase the data by collecting diet information and there’s a lot of highly relevant, new health information available. So, for most of us, the technology would appear to be a purely friendly thing.
But it could be used against us. Suppose a business constructed a model where it could alert obese, sedentary people, known through their past location data and credit card usage to frequent fast food restaurants. These people could then be given specific “offers” that would be more attractive and relevant to them than diet restriction and increasing exercise. From my perspective, I would chalk-up this use of the technology as a foe, because it is tantamount to an invasion of privacy. Now, what does all this mean for health and healthcare?
For healthcare provider organizations, indoor GPS has lots of applications. An obvious one is wayfinding. When my daughter needed a leg X-ray and cast removal last month, both services were located a distance from the clinic where they were ordered, and the path from place-to-place was literally a maze. Lots of little, tight hallways, closed doors, no signs or confusing signs, and lots of other sources of confusion. A smartphone app with indoor navigational GPS would be a friendly service, although unlikely to directly improve revenue or decrease cost for that provider organization.
This brings us back to the story opening this post. There seems to be at least one additional category needed beyond “Friend or Foe.” Should we routinely use continuous location monitoring and management as described in the MRSA story?
Many provider organizations have tagged individuals, including nurses, doctors, therapists, technicians, and others with devices that enable locating them with precise, real time and continuous tracking. By analyzing this information, it becomes possible to identify exactly when and where, for example, these folks wash their hands. Precise indoor GPS makes it possible to measure this behavior, and, after all, providers should wash their hands upon entering and leaving rooms where they interact with patients. So, it’s a good thing to monitor clinicians at all times. Right?
I propose we consider some additional word, a category, preferably starting with an “F” to describe a “Big Brother” technology that may be viewed by some as a necessity, but that is certainly intrusive. Yet, if we’re capturing this data as a byproduct of operations, can we justify not reviewing it and using it, as described in the opening Bob story? Whether or not Bob is being falsely accused, is this scenario fair to Bob and Bob's patients?
What do you think?