What You Will Learn
- 1 HEALTH AND HUMAN SERVICES
- 1.1 Making health and human services smarter
- 1.2 Dependencies in health and human services
- 1.3 Benefits of health and human services
- 1.4 Health and human services targets
- 1.5 Instrumentation and control
- 1.6 Privacy and security
- 1.7 Connectivity
- 1.8 Data management
- 1.9 Computing resources
- 1.10 Analytics
HEALTH AND HUMAN SERVICES
Advances in information and communications technologies (ICT) will transform the delivery of essential health and human services in powerful ways and smart cities will ride the wave to ensure a better life for residents.
Let’s imagine Los Angeles in the year 2030. An ill student is a home in bed, following her algebra instructor’s lesson over her smartphone. The instructor asks the class to solve for X, and our student raises her hand miles away to solve the equation in real-time. Later that night, through an app on the same phone, she downloads her algebra homework assignment and in a virtual classroom, she and her fellow students work together to apply the day’s lessons.
She finishes her homework and opens up a new app one that transmits data from her ongoing radiology treatment to her specialist in New York. She uses the mobile medical devices her hospital supplied and sends her health update off in a matter of minutes. Downstairs, her mother is online accessing her daughter’s medical records through the same portal that she has used to receive job training and employment referrals.
Welcome to the future of health and human services delivery, enabled by advanced technologies that will help smart cities improve the well-being of their citizens.
But before we dive too far into this chapter, let’s deal with some definitions. In the Readiness Guide we consider human services those that cities provide to support the wellbeing of residents their health and welfare, their education, the clean air they breathe and even the food they eat. Whereas in previous chapters we showed how ICT makes infrastructure smarter, in this chapter we explore how ICT empowers people to be smarter and healthier. The importance of smart human services can’t be understated after all, an educated and healthy city is a wealthy and successful city.
Making health and human services smarter
For our purposes, we have identified four interrelated and codependent categories of human services that ICT can transform to improve outcomes for city residents. As you look to transform these health and human service areas, it is important that you work with both public and private organizations and infrastructure in your city as often some of the assets involved are not owned by the city.
1. Public health is the macro, citywide view of health. Epidemiology, air quality, UV radiation, health research and development, population health management, food safety, health literacy and other large-scale issues are the concern of city public health agencies. Smart public health uses ICT to improve outcomes for citizens and cities alike. City agencies can use sensors to collect data on air quality, noise pollution, UV radiation, diseases and a host of other factors that impact public well-being. They can also proactively receive health information directly from citizens, by encouraging them to share their health feedback and experiences through mobile apps. This data can then be analyzed to detect trends and potential problems – and to inform city decision-making which might include anything from zoning laws to emission standards to mobilizing health providers to respond to an outbreak.
2. Health is how cities support the mental and physical well-being of residents. Today the traditional ways cities approached healthcare are being challenged by several factors, all of which have converged to place an enormous strain on already tight budgets:
• Non-communicable chronic diseases like heart disease, diabetes, obesity, stress, mental health problems and so on have grown significantly in the last decade, and are often concentrated in urban areas.
• Many regions of the world have inadequate health services that are strained by increasing demand at the same time populations are aging and people are living longer.
• Urban populations continue to swell around the globe; over half of all people now live in cities and the trend is expected to continue. The emerging discipline of smarter healthcare
– sometimes referred to as e-health or e-Care
– uses technology to overcome these challenges (and greatly improve outcomes) in these ways:
• It broadens and deepens access to health services.
• It addresses health factors holistically, across a broader range of city services and departments, and by focusing on prevention and healthier living.
• It supports better cooperation, collaboration and productivity between multidisciplinary and often geo-dispersed teams of health professionals.
Remote delivery of health services (as you’ll read about in case studies later in this chapter) makes it possible for a patient to receive advice and treatment from a doctor without having to leave home or work. And the doctor can assess and treat conditions in real-time and with maximum efficiency. This is one example of how smart cities use ICT to improve health – reaching more people in less time and using fewer resources without compromising the quality of health outcomes.
Here’s another: Health care providers are rapidly ditching paper-based patient medical records for electronic health records (EHRs). A doctor enters the exam room, chats with the patient and conducts an exam. The doctor then turns to a keyboard to enter data into fields on a computer screen. The patient’s health profile gets electronically updated right then and there.
There’s a big upside to having this digital version of a person’s medical history. It makes their diagnoses, lab tests, allergies, current prescriptions and other bits of health information easy to share and manage. It allows for the coordination of their care between clinicians. It helps control the administrative cost of delivering care. All of these are essentials in smart healthcare and certainly in smart cities that are proactive about enhancing livability for their residents.
Additionally, natural user interfaces and analytics can “learn” about patients as they grow a health history and suggest tailored and specific medical interventions of course, within the limits of security and privacy standards and with a person’s permission.
There’s also the convenience factor. A mother gets a text on her smartphone that it’s time for her child’s vaccination; she can make and/or reschedule the appointment on her phone or on a web portal. In so many ways, information can be a powerful tool in healthcare and ICT can help get it to the people who need it, when they need it.
3. Human services refer to a new and broader spectrum of easily accessed services that help people live better lives. These include services to help people deal with substance abuse, domestic violence, HIV/AIDS, nutrition
and physical fitness. It includes helping the homeless find beds to sleep in, disabled people find accessibility features across cities and dysfunctional families get counseling services.
While it is common for cities to treat health and human services separately, smart cities integrate a client’s human services history into their health portfolio for better outcomes and greater efficiency.
4. Education and skill development are a priority in a smart city. They provide opportunities for all ages and all levels, ranging from toddler story hours at the public library to computer classes at the senior center. K-12 education, workforce training programs and higher education are all essential. But today education is mostly stuck in the physical world. With the right deployment of ICT, cities can revolutionize the connection between student and teacher, school and learning.
Dependencies in health and human services
When planning improvements in the public health arena, it’s important for cities to recognize dependencies between healthcare services and other city systems and services. Clearly, public healthcare services rely heavily on a city’s public safety, communications and water systems. One example: The health of a city’s population is at risk if municipal water supplies are contaminated.
On the human services front, consider the dependencies between education and communications, energy systems and government administrative services. For example, enhancing communications technologies and access to them can help conquer the “digital divide” that challenges low-income students. The same communications technologies can improve access to remote education services. Local government policies are needed to support such programs.
Benefits of health and human services
Before we examine this chapter’s targets in detail, consider how smart health and human services enhance livability, workability and sustainability:
Improving patient satisfaction. One of the primary benefits of remote delivery of healthcare services or telemedicine – is increased patient satisfaction, especially for the elderly and mobility-challenged, but others too. Imagine if instead of taking time off work, making a trip to the doctor’s office and then sitting in a waiting room, you could transmit your health data on your own time, and your physician could review it with you via a video feed. Telemedicine eliminates much of the hassle associated with healthcare.
Improving the delivery of health, education and other human services. City services are often under-utilized because those most in need of them may not know they are available, aren’t sure they qualify or don’t know how to access them. An integrated, personalized citizen portal ensures easy, on-demand access to information people need.
Ensuring better, faster response to public health emergencies. The combination of smart devices, advanced and predictive analytics even social media – empower public health officials like never before. They can monitor the outbreak of a disease or a hazardous fuel spill in real-time, predict how it will spread and alert the public instantly through a wide range of communications channels.
Broadening access to healthcare. As cities grow larger, medical resources and access to expertise are stretched further and further. But ICT helps doctors reach as many patients as possible, improving health outcomes across
Preventing diseases and disorders before they emerge. ICT unearths an understanding of city populations that city health managers can use to build targeted prevention campaigns. What’s more, ICT can deliver these campaigns directly to citizens’ fingertips so that information is widely digested and acted upon.
Improved public health means fewer work hours missed. A 2012 study estimated that illness cost the United States economy around $576 billion a year. Cities that use ICT to bolster awareness of public health issues and promote remedies optimize their citizens’ well-being, which translates into a more productive workforce and a stronger economy as a result.
Smart education makes a city more attractive to business and talent. Cities that make education a priority and use technology to empower current and future workers with a superior education and continuing online education and training – particularly in high-demand fields such as math, science and technology – can capitalize on this demand to draw new businesses and investment that bolsters the local economy.
Smart healthcare and social services make a city more attractive to business and talent too. Cities that offer access to state-of-the-art healthcare and social service programs have a competitive advantage in attracting the creative class of tomorrow. Put simply, if you’re a top talent, you’re not going to locate your family somewhere they’d have to leave when they needed quality health and human services.
Telemedicine is cost-effective. By promoting its use, cities can ensure that medical providers can perform more great work with fewer resources.
Reduced long-term health costs. By deploying smart devices that measure and monitor public health conditions, and then using that information to inform decisions citywide, cities can take steps to potentially reduce the cost of healthcare through prevention campaigns.
Smart learning means less travel. Improved service delivery of educational opportunities utilizing ICT cuts down on travel, which promotes the conservation of energy resources.
Health and human services targets
As you’ll see in the pages that follow, there are two targets specific to this health and human services chapter and they will be discussed in detail. We’ll also explain how other universal targets apply to health and human services.
Instrumentation and control
Health and human services use instrumentation and control in two slightly different ways, but the primary mission remains the same as in other city responsibility areas. It’s all about data collection.
Implement optimal devices and other instrumentation for each human service. Implementing the right data-capturing devices across all of a city’s health and human services responsibility areas is the objective here. Given the new and different types of services involved, different kinds of instrumentation will be required.
For instance in a smart city, instrumentation can include smartphones and apps that allow people to directly participate in city public health and human services monitoring by providing feedback about conditions and experiences. For example, Council Partner IBM has created the Accessible Way app that allows users to report on the accessibility of their cities, and in doing so help construct a crowd-sourced knowledge base about urban mobility challenges.
In healthcare, social services and education arenas, devices collect data from people for the most part. These include devices that may monitor how patients in a study are responding to a new medication or ones that record academic progress in a new teacher’s classroom. The purpose is to provide actionable data that can be analyzed for trends or
Data-capturing devices are critical for the telemedicine systems mentioned earlier. Patients use devices to acquire data on their health status in the comfort of their homes and then transmit it to remote care providers. This greater efficiency can save time, money and resources. Similar savings can occur when health professionals remotely monitor patients with chronic conditions like diabetes or heart disease. And the opportunity to use ICT for realtime, interactive checkups allows physicians to deliver emergency medical help that can save lives where more time-consuming traditional medicine may be too late.
In education, there are many ways to improve outcomes through ICT. Applying data analytics to test results, attendance and graduation rates can help pinpoint problems and trends. Today’s smart devices combined with all manner of web apps and social media tools connect students to teachers, to other students and to diverse learning opportunities in ways never imagined a few short years ago. In one example, school-owned smartphones that allowed a 24/7 wireless connection to teachers improved algebra proficiency results by 30 percent.
Privacy and security
Nowhere perhaps is privacy and security more critical than in health and human services. Citizens must be able to completely trust the public agencies that maintain files with what may be very sensitive personal information. These targets outline how smart cities handle this.
Publish privacy rules. Even though there are often very specific laws regarding how health information is handled, smart cities still need to be very transparent about their commitment to safeguarding the privacy of all citizens.
Create a security framework. Mitigate risk by taking a proactive approach to security – identifying and addressing threats before they can cause damage.
Implement cybersecurity. Cybercrimes are on the rise and this is another critical step toward protecting data that may reveal sensitive personal information about citizens served by health and human service agencies. Implementing cybersecurity early on maximizes protection while minimizing costs.
De-identify patient and student data for storage and research in the cloud. Before storing health and human services data in the cloud, it’s imperative to remove any personally identifying information that ties an individual to specific data. That helps protect a person’s privacy in the event the data is stolen or otherwise compromised.
By taking these steps, cities will do much to assuage potential privacy concerns that could become a barrier to telemedicine or other advances in health and human services technologies.
We talked earlier about how public health agencies use smart devices and other instrumentation to collect data about air quality, disease outbreaks and the like. Collecting it is only a starting place.
Connect devices with citywide, multi-service communications. Connecting the smart devices deployed around cities for public health data-capture to a citywide communications system is important for realizing improved public health outcomes in the same way that smart gas or water meters must be connected to optimize those infrastructures. Water quality monitors that detect a chemical leak that could contaminate a popular swimming beach isn’t useful unless the information is communicated in real-time to all of the city departments that might need to get involved.
To reinforce the privacy and security strategies highlighted in the previous section, smart cities will want to make sure all departments are following the same rules.
Create and adhere to citywide data management, transparency and sharing policy. Again, due to the sensitive nature of data involving health and human services, it goes without saying that a policy needs to be very explicit about who owns which data sets, who has access, how it can be shared and when it should not be shared.
Architect a single health history for citizens. As we mentioned earlier, smart cities integrate personal health data from their different agencies and departments so that patients can enjoy the benefits of single health history. This repository can be more than passive storage – it can be online, security-enhanced storage, sharing and services platform that citizens can access.
There’s nowhere in a smart city that computing resources aren’t a major player. Below is a quick refresher on four targets to consider in a health and human services context.
Consider a cloud computing framework. Cloud computing has become more affordable and more prevalent. Smart cities of all sizes may see advantages in the cloud’s scalability, reliability and cost. However, as we mentioned earlier, before uploading personally identifiable health and human services data to the cloud, steps must be taken to “de-identify” it.
Use an open innovation platform. An open innovation platform empowers innovators. And the possibilities in the health and human services arena are limitless. In New York City, for example, residents can download an app that provides all sorts of useful information about local restaurants – including what grade they received in their most recent health inspections.
Have access to a central GIS. With health and human service agencies spread out in many parts of a city, a GIS will prove useful for smart cities. A central GIS enables efficiency gains through more intelligent scheduling and routing, it provides improved accuracy of essential records and boosts the resiliency of key assets.
Have access to comprehensive device management. It’s important to include devices used by health and human services workers in the field – smartphones, laptops, etc. – as part of a city’s device management system to ensure they comply with city data management, security and privacy policies.
The four targets highlighted here demonstrate how analytics are particularly important as cities monitor trends and developments in public health.
Achieve full situational awareness. Smart cities use monitoring devices to take the pulse of the city and its people. Situational awareness aids that effort by increasing the reliability and resiliency of the public health infrastructure and those monitoring devices, allowing for quick response to incidents that threaten public health and well-being.
Achieve operational optimization. Analytics help cities ensure the best possible public health outcomes. For example, they may reveal a sudden shift in air quality in a particular part of a city that requires corrective action. Or analysis of health, records may reveal an abnormally high number of lung cancer cases in a community, prompting an investigation by public health officials.
Achieve asset optimization. The objective here is to ensure maximum value is extracted from a city’s investments in health and human services infrastructure – which includes everything from computers in offices to field devices that monitor things like water quality at public beaches. Calculating precisely which assets should be replaced or repaired and when helps achieve maximum return on investment.
Pursue predictive analytics. Analyzing health and human services data to spot patterns and trends and take action before situations worsen can make a city more livable. By monitoring the path and characteristics of a virus, for instance, public health officials can predict where it will strike next and alert residents how they can protect themselves.
As we’ve said, predictive analytics can also help people understand what their own health might look like in the future, offering an incentive for behavior changes.