SIEMENS

Helga Hohmann turns on the TV shortly after she wakes up. The screen displays her user name, after which Helga, who is 72 years old, enters her password. Large icons immediately appear with headings like “Communication,” “Health,” “Assistance,” “At Home,” and “Calendar.” Helga clicks on “Calendar” to view the schedule she has made up for today. She has a doctor’s appointment at 11, a physical therapy session at 3, and a date with friends at 6. However, none of this will require her to leave her comfortable apartment, as every appointment will take place virtually — via her television’s service portal, which includes an audio-video communication system.

This is how life might be for senior citizens in coming years in a world with Ambient Assisted Living (AAL) systems, which allow them to remain independent, healthy, safe, and mobile for longer periods of time. Demographic developments make it clear that something has to be done. For example, one out of every three people in Germany will be older than 60 by 2035. In response to such developments, a research project called “SmartSenior” has brought together 28 industrial firms and research organizations under the direction of Deutsche Telekom Laboratories (T-Labs). Participating companies include Siemens, BMW, Alcatel-Lucent, Charité University Hospital in Berlin, the German Research Center for Artificial Intelligence, the Technical University (TU) of Berlin, and the GEWOBA real estate management company in Potsdam. Germany’s Ministry of Education and Research has provided €24 million in project funding, with an additional €17 million coming from industrial companies, including €5 million from Siemens (see Pictures of the Future, Fall 2010, Coming Home).

The project, which was launched in 2009, consists of nine sub-projects for developing innovations that integrate information and communication technologies and services, including emergency assistance services, household safety solutions, social networking systems, and telemedicine service centers. The main challenge lies in the standardization and integration of various devices — from televisions and smartphones to household appliances and cars. “SmartSenior is the leader in Europe when it comes to its scope and its objective of integrating so many services into a single platform,” says Michael Balasch, Research & Innovation Director at T-Labs and overall coordinator of the SmartSenior consortium.

Field Test with Seniors. A three-month field test to be launched in the spring of 2012 will show whether all the technologies fit together and how well they’re accepted by users. To this end, 35 existing apartments in Potsdam will be equipped with a high-speed Internet connection and data hub known as the AAL Home Gateway and with various room sensors. All residents will be 50 or older. The model apartment for the test in Potsdam has a flatscreen in the living room that displays the SmartSenior interface, a set-top box for high-resolution audio- video communication via the television, a camera, and a hands-free phone. Sensors in the window frames register whether windows are open or closed, while palm-sized sensors in the ceiling collect information on the temperature, lighting conditions, and possible gas leaks. Most of these sensors operate autonomously and transfer their data to the Gateway.

“It only takes the system a week to learn a resident’s daily routine on the basis of the sensor data,” says Karsten Raddatz from TU Berlin. If the senior leaves the house and leaves a window open that would normally be closed, he or she can be sent a message on their smartphone. Data on the senior’s movements is also valuable. Consider the following example: A resident goes to the bathroom between 2 a.m. and 3 a.m. as usual, but doesn’t return to the bedroom within ten minutes as he normally does. The system will register this anomaly and send a signal to an assistance center, which will then attempt to contact the senior by phone. If this attempt fails, the assistance center will notify an emergency rescue center.

The personalization possibilities the system offers and the modular nature of the solutions are very important because, as Balasch points out, “each senior citizen is unique.” Some older people are more mobile than others and can use the platform to maintain contact with family and friends, while using its comfort services to make their lives easier. Others are susceptible to falls or are in danger of having a stroke. That’s why the field test also includes an interactive trainer for preventing falls. It may even be possible later on for hospital or emergency services staff to utilize the video function in order to get an idea of what’s going on before they arrive — assuming that the user has approved the use of such a function. Siemens is also developing a watch that registers the movements and vital data of those who wear it, and then transmits the information to the AAL Home Gateway (see Pictures of the Future, Fall 2010, "Coming Home").

Flexible Use. ”We’ve come up with different scenarios that bring together medical, user-relevant, and individual goals,” says Stefan Göllner from TU Berlin and the T-Lab Quality and Usability Lab. Here, user groups consist of seniors and their families, physicians, emergency medical technicians, physical therapists, and other service providers as secondary and cousers. All of these potential users will be networked through the SmartSenior Service portal. They will be accessible via stationary or mobile communication devices to handle emergencies, regularly scheduled consultations, and interactive training sessions — for example, during physical rehabilitation periods after a fall or stroke. Users’ fears were taken into account in the scenarios. For example, some people might be nervous about having to use the technology or afraid that they’re being watched.

In order to allay these fears, SmartSenior devices have been designed to blend in perfectly with the users’ normal surroundings. No resident or visitor will even notice at first glance that an apartment is fitted with technical assistance systems. The set-top box, for example, is a non-medical communication component that looks like a video recorder, the sensors in the window frames and ceilings are similar in size and design to smoke and burglar alarms, and the AAL Home Gateway and the Med-I-Box medical communication unit can be installed anywhere in the home. Due to legal considerations, the field test doesn’t offer participants any real medical services, however. Emergencies are therefore only being simulated in order to test how well the assistance systems work and how users interact with one another.

Helga Hohmann is one of the fictitious individualscreated for a SmartSenior scenario. She has had several hip operations and uses public transport to go to the doctor, but has also expressed the desire to meet with her doctor “with less of a hassle.” That’s why the scenario has her calling up her personal patient file shortly after 11 a.m. via the SmartSenior platform’s “Health” icon on her TV screen. She checks her vital signs, which the sensors in her watch, her pulse oximeter, and external devices have sent to the system. The screen then shows her pulse, body temperature, blood pressure, and respiratory rates. She can now use the remote control to activate the “Televisit” audio-video connection. A short time later she will be greeted by a doctor’s assistant at the telemedicine center, who will then pass her on to her physician. “It’s important that the user should be able to recognize the interactive elements and operate them intuitively on the TV and with mobile terminals such as smartphones,” Göllner explains.

“A telemedicine visit proceeds like a normal trip to a doctor or a house call,” says Dr. Martin Schultz, head of the Telemedicine Center at Charité Hospital (TMCC) in Berlin. In this setup, a nurse can act as a receptionist by requesting information on the patient’s condition and preparing his or her electronic patient file. The physician then obtains data on possible illnesses, symptoms, and medications being taken. All previous diagnoses can be viewed at the SmartSenior portal. “The data for the patient and the doctor will be processed and presented differently,” Schultz explains. The electronic patient file contains all relevant information, such as ECG results, blood pressure, medications, etc. Says Schultz: “Everything is checked by an automatic diagnosis system. Other doctors can be called in for consultations if necessary, and medical databases can be accessed to determine the possible interactions of various medications.”

More Effective Service. The TMCC is developing the project’s telemedicine service center, which operates like a call center in which incoming calls are prioritized and forwarded. There are various service levels, each with its own area of expertise. Caregivers, nurses, and emergency medical technicians work on the first level. “They act as medical agents and need to be trained to communicate accordingly,” says Schultz. The second level consists of doctors with high availability who can react quickly, as well as highly-skilled specialists who are not always available. Telemedicine staff members work at computer screens with highresolution audio-video systems. “Obviously, a physician who actually meets with a patient will be able to obtain nonverbal information through a manual examination or even through perceptions of things such as odors,” Schultz explains. “But some of this information can also be collected in telemedicine by the physical presence of family members, a nurse or a physical therapist.” Telemedicine is an attractive option for seniors, not only in cities, but also in rural areas with a shortage of doctors. In emergency situations, telemedicine physicians can explain to people how to help themselves until professional assistance arrives.

Medical information collection by sensors that measure and transmit data on oxygen saturation, movement, and heart and respiratory rates offers other benefits as well — for instance, by helping to prevent automobile accidents. BMW, for example, is developing an emergency stop assistance system for project scenarios in which a driver looses consciousness because of a heart attack.

The emergency stop assistant would then automatically take control of the vehicle, turn on the hazard lights, and safely steer the car to the shoulder. The unit would also use sensor technology in radars, laser scanners, and cameras to determine the positions of other vehicles and pedestrians, while at the same time transmitting relevant medical data and the precise location of the vehicle to an emergency rescue center.

Multifaceted Target Group. ”The SmartSenior target group consists of all elderly individuals,” says Dr. Mehmet Gövercin, Deputy Director of the Geriatric Research Group at Charité Hospital. Gövercin believes this target group is especially in need of intelligent and innovative solutions: “The older people get, the more personalized the solutions have to be — after all, there are 55-year-olds who have strokes and 80-year-olds who run marathons.” Gövercin’s group works at the interface between research and practice to develop solutions for preventing falls and strokes and for implementing subsequent rehabilitation measures. This is important, as more than one million people in Germany now live with the aftereffects of a stroke. Other SmartSenior project partners address different issues. Vivantes, for example, is responsible for dialysis, while the Berlin Pain Center and the Klinikum Südstadt Rostock hospital develop pain treatments.

Falls are another big problem. One out of three 65-year-olds in Germany suffers a fall at least once a year, as do more than 80 percent of people over 80. The cost of treating the effects of such falls in Germany is estimated to be €500 million per year, according to the Geriatric Research Group. Moving back home after a hospital or rehabilitation stay is often difficult, as patients become less motivated and neglect their training and exercise. “These people need to keep doing intense exercise for a long time,” says Gövercin, “and a home interactive training system can make sure they continue their training with the help of physical therapists.” That’s why an interactive trainer is also being tested in the field study. Gövercin knows from his own daily experience that seniors enjoy using computers and communication technology if they clearly see and understand their utility. “Elderly people are anything but technophobic,” he says.

The overriding objective is always to improve the quality of life for seniors and allow them to remain independent. But the project also focuses on reducing the costs associated with hospital stays, which would ease the burden on health insurance companies. To this end, SmartSenior will try to determine the extent to which some of these goals can actually be achieved. Balasch is confident that the project’s three-month field test will yield extensive new knowledge regarding the interaction between its system components and senior citizens’ acceptance of the overall system. Still, project partners will continue to face many challenges even after the research project concludes in 2012. For one thing, they will have to transform proven solutions into marketable products. Moreover, the legal situation remains unclear with regard to systems such as the emergency stop assistant and the interface between medical and non-medical products. Finally, health insurers are only willing to pay for medical services whose efficiency has beendemonstrated, which is why there still aren’t any fee scales for telemedicine.

Interest among Young and Old. The CeBIT 2011 trade fair showed the project partners that SmartSenior could be a big sales hit, as it became clear that the system would sell quickly if it were already available. Seniors lined up and said, “We want to take it home!” Young people were also impressed, as the SmartSenior service portal allows users to make purchases and order meals online, notify landlords of problems in an apartment, make appointments at the hairdresser’s, and access social networks.

Our fictitious user Helga Hohmann would thus not only be able to contact her doctor via the SmartSenior portal but also her family and friends. “Hello, Helga!” a pleasant voice might call out of the TV at 6 p.m. Helga’s friend Gerda would then appear on the screen, which might also split to reveal the virtual presence of Helga’s friend Klaus and his wife waving and smiling into the camera. With SmartSenior, the friends could meet virtually once a week or more and interact almost as if they were sitting together. Tonight that won’t be enough, though, so they decide to meet for dinner. Helga puts on a vest that no one will ever know is fitted with sensors, as is her watch. She leaves her apartment with a good feeling, because she knows her SmartSenior network will keep her safe tonight.