Negligent nurses? Or dodgy digital? – device design can unintentionally mask errors

Magicians often fool their audience into ‘looking over there’ (literally or metaphorically), getting them to pay attention to the wrong thing so that they’re not focusing on what the magician is doing and can enjoy the trick without seeing how it was done. Computers, phones and medical devices let you interact with them using a human-friendly interface (such as a ‘graphical user interface’) which make them easier to use, but which can also hide the underlying computing processes from view. Normally that’s exactly what you want but if there’s a problem, and one that you’d really need to know about, how well does the device make that clear? Sometimes the design of the device itself can mask important information, sometimes the way in which devices are used can mask it too. Here is a case where nurses were blamed but it was later found that the medical devices involved, blood glucose meters, had (unintentionally) tripped everyone up. A useful workaround seemed to be working well, but caused problems later on.

At the end you can find more links between magic and computer science, and human-computer interaction.

Negligent nurses? Or dodgy digital?

by Harold Thimbleby, Swansea University and Paul Curzon, Queen Mary University of London

It’s easy to get excited about new technology and assume it must make things better. It’s rarely that easy. Medical technology is a case in point, as one group of nurses found out. It was all about one simple device and wearable ID bracelets. Nurses were taken to court, blamed for what went wrong.

The nurses taken to court worked in a stroke unit and were charged with wilfully neglecting their patients. Around 70 others were also disciplined though not sent to court.

There were problems with many nurses’ record-keeping. A few were selected to be charged by the police on the rather arbitrary basis that they had more odd records than the others.

Critical Tests

The case came about because of a single complaint. As the hospital, and then police, investigated, they found more and more oddities, with lots of nurses suddenly implicated. They all seemed to have fabricated their records. Repeatedly, their paper records did not tally with the computer logs. Therefore, the nurses must have been making up the patient records.

The gadget at the centre of the story was a portable glucometer. Glucometers allow the blood-glucose (aka blood sugar) levels of patients to be tested. This matters. If blood-sugar problems are not caught quickly, seriously ill patients could die.

Whenever they did a test, the nurses recorded it in the patient’s paper record. The glucometer system also had a better, supposedly infallible, way to do this. The nurse scanned their ID badge using the glucometer, telling it who they were. They then scanned the patient’s barcode bracelet, and took the patient’s blood-sugar reading. They finally wrote down what the glucometer said in the paper records, and the glucometer automatically added the reading to that patient’s electronic record.

Over and over again, the nurses were claiming in the notes of patients that they had taken readings, when the computer logs showed no reading had been taken. As machines don’t lie, the nurses must all be liars. They had just pretended to take these vital tests. It was a clear case of lazy nurses colluding to have an easy life!

What really happened?

In court, witnesses gave evidence. A new story unfolded. The glucometers were not as simple as they seemed. No-one involved actually understood them, how the system really worked, or what had actually happened.

In reality the nurses were looking after their patients … despite the devices.

The real story starts with those barcode bracelets that the patients wore. Sometimes the reader couldn’t read the barcode. You’ve probably seen this happen in supermarkets. Every so often the reader can’t tell what is being scanned. The nurses needed to sort it out as they had lots of ill patients to look after. Luckily, there was a quick and easy solution. They could just scan their own ID twice. The system accepted this ‘double tapping’. The first scan was their correct staff ID. The second scan was of their staff card ID instead of the patient ID. That made the glucometer happy so they could use it, but of course they weren’t using a valid patient ID.

Self service till

Supermarket till from I See Modern Britain on Flickr.

As they wrote the test result in the patient’s paper record no harm was done. When checked, over 200 nurses sometimes used double tapping to take readings. It was a well-known (at least by nurses), and commonly used, work-around for a problem with the barcode system.

The system was also much more complicated than that anyway. It involved a complex computing network, and a lot of complex software, not just a glucometer. Records often didn’t make it to the computer database for a variety of reasons. The network went down, manually entered details contained mistakes, the database sometimes crashed, and the way the glucometers had been programmed meant they had no way to check that the data they sent to the database actually got there. Results didn’t go straight to the patient record anyway. It happened when the glucometer was docked (for recharging), but they were constantly in use so might not be docked for days. Indeed, a fifth of the entries in the database had an error flag indicating something had gone wrong. In reality, you just couldn’t rely on the electronic record. It was the nurses’ old fashioned paper records that really were the ones you could trust.

The police had got it the wrong way round! They thought the computers were reliable and the nurses untrustworthy, but the nurses were doing a good job and the computers were somehow failing to record the patient information. Worse, they were failing to record that they were failing to record things correctly! … So nobody realised.

Disappearing readings

What happened to all the readings with invalid patient IDs? There was no place to file them so the system silently dropped them into a separate electronic bin of unknowns. They could then be manually assigned, but no way had been set up to do that.

During the trial the defence luckily noticed an odd discrepancy in the computer logs. It was really spiky in an unexplained way. On some days hardly any readings seemed to be taken, for example. One odd trough corresponded to a day the manufacturer said they had visited the hospital. They were asked to explain what they had done…

The hospital had asked them to get the data ready to give to the police. The manufacturer’s engineer who visited therefore ‘tidied up’ the database, deleting all the incomplete records…including all the ones the nurses had supposedly fabricated! The police had no idea this had been done.

Suddenly, no evidence

When this was revealed in court, the judge ruled that all the prosecution’s evidence was unusable. The prosecution said, therefore, they had no evidence at all to present. In this situation, the trial ‘collapses’: the nurses were completely innocent, and the trial immediately stopped.

The trial had already blighted the careers of lots of good nurses though. In fact, some of the other nurses pleaded guilty as they had no memory of what had actually happened but had been confronted with the ‘fact’ that they must have been negligent as “the computers could not lie”. Some were jailed. In the UK, you can be given a much shorter jail sentence, or maybe none at all, if you plead guilty. It can make sense to plead guilty even if you know you aren’t — you only need to think the court will find you guilty. Which isn’t the same thing.

Silver bullets?

Governments see digitalisation as a silver bullet to save money and improve care. It can do that if you get it right. But digital is much harder to get right than most people realise. In the story here, not getting the digital right — and not understanding it — caused serious problems for lots of nurses.

It takes skill and deep understanding to design digital things to work in a way that really makes things better. It’s hard for hospitals to understand the complexities in what they are buying. Ultimately, it’s nurses and doctors who make it work. They have to.

They shouldn’t be automatically blamed when things go wrong because digital technology is hard to design well.


This article was originally published on the CS4FN website and a copy can be found in Issue 25 of the CS4FN magazine, below.


Related Magazine …


Magic Book

There are a number of surprising parallels between magic and computer science and so we have a number of free magic booklets (The Magic of Computer Science 1, 2 and 3 among others) to tell you all about it. The booklets show you some magic and talk about the links with computing and computational thinking. From the way a magician presents a trick (and the way in which people interact with devices) to self-working tricks which behave just like an algorithm. For the keenest apprentices of magic we also have a new book ⬇️, Conjuring with Computation, which you can buy from bookshops or as an e-book. Here are a couple of free bonus chapters.

EPSRC supports this blog through research grant EP/W033615/1.

Gladys West: Where’s my satellite? Where’s my child? #BlackHistoryMonth

Satellite image of the Earth at night

by Paul Curzon, Queen Mary University of London

Satellites are critical to much modern technology, and especially GPS. It allows our smartphones, laptops and cars to work out their exact position on the surface of the earth. This is central to all mobile technology, wearable or not, that relies on knowing where you are, from plotting a route your nearest Indian restaurant to telling you where a person you might want to meet is. Many, many people were involved in creating GPS, but it was only in Black History Month of 2017 when the critical part Gladys West played became widely known.

Work hard, go far

As a child Gladys worked with her family in the fields of their farm in rural Virginia. That wasn’t the life she wanted, so she worked hard through school, leaving as the top student. She won a scholarship to university, and then landed a job as a mathematician at a US navy base.

There she solved the maths problems behind the positioning of satellites. She worked closely with the programmers to write the code to do calculations based on her maths. Nine times out of ten the results that came back weren’t exactly right so much of her time was spent working out what was going wrong with the programs, as it was vital the results were very accurate.

Seasat and Geosat

Her work on the Seasat satellite won her a commendation. It was a revolutionary satellite designed to remotely monitor the oceans. It collected data about things like temperature, wind speed and wind direction at the sea’s surface, the heights of waves, as well as sensing data about sea ice. This kind of remote sensing has since had a massive impact on our understanding of climate change. Gladys specifically worked on the satellite’s altimeter. It was a radar-based sensor that allowed Seasat to measure its precise distance from the surface of the ocean below. She continued this work on later remote sensing satellites too, including Geosat, a later earth observation satellite.

Gladys West and Sam Smith look over data from the Global Positioning System,
which Gladys helped develop. Photo credit US Navy, 1985, via Wikipedia.

GPS

Knowing the positions of satellites is the foundation for GPS. The way GPS works is that our mobile receivers pick up a timed signal from several different satellites. Calculating where we are can only be done if you first know very precisely where those satellites were when they sent the signal. That is what Gladys’ work provided.

GPS Watches

You can now buy, for example, buy GPS watches, allowing you to wear a watch that watches where you are. They can also be used by people with dementia, who have bad memory problems, allowing their carers to find them if they go out on their own but are then confused about where they are. They also allow parents to know where their kids are all the time. Do you think that’s a good use?

Since so much technology now relies on knowing exactly where we are, Gladys’ work has had a massive impact on all our lives.

This article was originally published on the CS4FN website and a copy can also be found on page 14 of Issue 25 of CS4FN, “Technology worn out (and about)“, on wearable computing, which can be downloaded as a PDF, along with all our other free material, here: https://cs4fndownloads.wordpress.com/  

This article is also republished during Black History Month and is part of our Diversity in Computing series, celebrating the different people working in computer science (Gladys West’s page).


This blog is funded through EPSRC grant EP/W033615/1.

Microwave health check – using wearable tech to monitor elite athletes’ health

Microwave health check

by Tina Chowdhury, Institute of Bioengineering, School of Engineering and Materials Science, Queen Mary University of London

Black and white photo of someone sweating after exertion
Image by un-perfekt from Pixabay

Microwaves aren’t just useful for cooking your dinner. Passing through your ears they might help check your health in future, especially if you are an elite athlete. Bioengineer Tina Chowdhury tells us about her multidisciplinary team’s work with the National Physics Laboratory (NPL).   Lots of wearable gadgets work out things about us by sensing our bodies. They can tell who you are just by tapping into your biometric data, like fingerprints, features of your face or the patterns in your eyes. They can even do some of this remotely without you even knowing you’ve been identified. Smart watches and fitness trackers tell you how fast you are running, how fit you are and whether you are healthy, how many calories you have burned and how well you are sleeping or not sleeping. They also work out things about your heart, like how well it beats. This is done using optical sensor technology, shining light at your skin and measuring how much is scattered by the blood flowing through it.  

Microwave Sensors

With PhD student, Wesleigh Dawsmith, and electronic engineer, microwave and antennae specialist, Rob Donnan, we are working on a different kind of sensor to check the health of elite athletes. Instead of using visible light we use invisible microwaves, the kind of radiation that gives microwave ovens their name. The microwave-based wearables have the potential to provide real-time information about how our bodies are coping when under stress, such as when we are exercising, similar to health checks without having to go to hospital. The technology measures how much of the microwaves are absorbed through the ear lobe using a microwave antenna and wireless circuitry. How much of the microwaves are absorbed is linked to being dehydrated when we sweat and overheat during exercise. We can also use the microwave sensor to track important biomarkers like glucose, sodium, chloride and lactate which can be a sign of dehydration and give warnings of illnesses like diabetes. The sensor sounds an alarm telling the person that they need medication, or are getting dehydrated, so need to drink some water. How much of the microwaves are absorbed is linked to being dehydrated

Making it work

We are working with with Richard Dudley at the NPL to turn these ideas into a wearable, microwave-based dehydration tracker. The company has spent eight years working on HydraSenseNPL a device that clips onto the ear lobe, measuring microwaves with a flexible antenna earphone.

Blue and yellow sine wave patterns representing light
Image by Gerd Altmann from Pixabay

A big question is whether the ear device will become practical to actually wear while doing exercise, for example keeping a good enough contact with the skin. Another is whether it can be made fashionable, perhaps being worn as jewellery. Another issue is that the system is designed for athletes, but most people are not professional athletes doing strenuous exercise. Will the technology work for people just living their normal day-to-day life too? In that everyday situation, sensing microwave dynamics in the ear lobe may not turn out to be as good as an all-in-one solution that tracks your biometrics for the entire day. The long term aim is to develop health wearables that bring together lots of different smart sensors, all packaged into a small space like a watch, that can help people in all situations, sending them real-time alerts about their health.

This article was originally published on the CS4FN website and a copy can also be found on page 8 of Issue 25 of CS4FN, “Technology worn out (and about)“, on wearable computing, which can be downloaded as a PDF, along with all our other free material, here: https://cs4fndownloads.wordpress.com/  


 


This blog is funded through EPSRC grant EP/W033615/1.

Full metal jacket: the fashion of Iron Man

by Peter W McOwan and Paul Curzon, Queen Mary University of London

Spoiler Alert

Industrialist Tony Stark always dresses for the occasion, even when that particular occasion happens to be a fight with the powers of evil. His clothes are driven by computer science: the ultimate in wearable computing.

In the Iron Man comic and movie franchise Anthony Edward Stark, Tony to his friends, becomes his crime fighting alter ego by donning his high tech suit. The character was created by Marvel comic legend Stan Lee and first hit the pages in 1963. The back story tells how industrial armaments engineer and international playboy Stark is kidnapped and forced to work to develop new forms of weapons, but instead manages to escape by building a flying armoured suit.

Though the escape is successful Stark suffers a major heart injury during the kidnap ordeal, becoming dependant on technology to keep him alive. The experience forces him to reconsider his life, and the crime avenging Iron Man is born. Lee’s ‘businessman superhero’ has proved extremely popular and in recent years the Iron Man movies, starring Robert Downey Jr, have been box office hits. But as Tony himself would be the first to admit, there is more than a little computer science supporting Iron Man’s superhero standing.

Suits you

The Iron Man suit is an example of a powered exoskeleton. The technology surrounding the wearer amplifies the movement of the body, a little like a wearable robot. This area of research is often called ‘human performance augmentation’ and there are a number of organisations interested in it, including universities and, unsurprisingly, defence companies like Stark Industries. Their researchers are building real exoskeletons which have powers uncannily like those of the Iron Man suit.

To make the exoskeleton work the technology needs to be able to accurately read the exact movements of the wearer, then have the robot components duplicate them almost instantly. Creating this fluid mechanical shadow means the exoskeleton needs to contain massive computing power, able to read the forces being applied and convert them into signals to control the robot servo motors without any delay. Slow computing would cause mechanical drag for the wearer, who would feel like they were wading through treacle. Not a good idea when you’re trying to save the world.

Pump it up

Humans move by using their muscles in what are called antagonistic pairs. There are always two muscles on either side of the joint that pull the limb in different directions. For example, in your upper arm there are the muscles called the biceps and the triceps. Contracting the biceps muscle bends your elbow up, and contracting your triceps straightens your elbow back. It’s a clever way to control biological movement using just a single type of shortening muscle tissue rather than needing one kind that shortens and another that lengthens.

In an exoskeleton, the robot actuators (the things that do the moving) take the place of the muscles, and we can build these to move however we want, but as the robot’s movements need to shadow the person’s movements inside, the computer needs to understand how humans move. As the human bends their elbow to lift up an object, sensors in the exoskeleton measure the forces applied, and the onboard computer calculates how to move the exoskeleton to minimise the resulting strain on the person’s hand. In strength amplifying exoskeletons the actuators are high pressure hydraulic pistons, meaning that the human operators can lift considerable weight. The hydraulics support the load, the humans movements provide the control.

I knew you were going to do that

It is important that the human user doesn’t need to expend any effort in moving the exoskeleton; people get tired very easily if they have to counteract even a small but continual force. To allow this to happen the computer system must ensure that all the sensors read zero force whenever possible. That way the robot does the work and the human is just moving inside the frame. The sensors can take thousands of readings per second from all over the exoskeleton: arms, legs, back and so on.

This information is used to predict what the user is trying to do. For example, when you are lifting a weight the computer begins by calculating where all the various exoskeleton ‘muscles’ need to be to mirror your movements. Then the robot arm is instructed to grab the weight before the user exerts any significant force, so you get no strain but a lot of gain.

Flight suit?

Exoskeleton systems exist already. Soldiers can march further with heavy packs by having an exoskeleton provide some extra mechanical support that mimics their movements. There are also medical applications that help paralysed patients walk again. Sadly, current exoskeletons still don’t have the ability to let you run faster or do other complex activities like fly.

Flying is another area where the real trick is in the computer programming. Iron Man’s suit is covered in smart ‘control surfaces’ that move under computer control to allow him to manoeuvre at speed. Tony Stark controls his suit through a heads-up display and voice control in his helmet, technology that at least we do have today. Could we have fully functional Iron Man suits in the future? It’s probably just a matter of time, technology and computer science (and visionary multi-millionaire industrialists too).


More on …

Related Magazines …


This blog is funded through EPSRC grant EP/W033615/1.

Let buttons be buttons

by Paul Curzon, Queen Mary University of London

Assorted buttons including Rebecca Stewart's integrated circuit button
Image by Melly95 from Pixabay with added integrated circuit button by Rebecca Stewart

We are used to the idea that we use buttons with electronics to switch things on and off, but Rebecca Stewart and Sophie Skach decided to use real
buttons in the old-fashioned sense of a fashionable way to fasten up clothes.

Rebecca created integrated circuit buttons – electronics, sensors and a battery inside an actual button. Sophie then built them into a stylish jacket that included digital embroidery, embedding lighting and the circuitry to control it into the fabric of the jacket.

How do you control the light effects?

You just button and unbutton the jacket of course


Design your own

If you are interested in fashion design, why not design of a jacket, dress or shirt of your own that uses wearable technology. What would it do and how would you control it?

More on …

Related Magazines …


This blog is funded through EPSRC grant EP/W033615/1.

Smart bags

In our stress-filled world with ever increasing levels of anxiety, it would be nice if technology could sometimes reduce stress rather than just add to it. That is the problem that QMUL’s Christine Farion set out to solve for her PhD. She wanted to do something stylish too, so she created a new kind of bag: a smart bag.

Christine realised that one thing that causes anxiety for a lot of people is forgetting everyday things. It is very common for us to forget keys, train tickets, passports and other everyday things we need for the day. Sometimes it’s just irritating. At other times it can ruin the day. Even when we don’t forget things, we waste time unpacking and repacking bags to make sure we really do have the things we need. Of course, the moment we unpack a bag to check, we increase the chance that something won’t be put back!

Electronic bags

Christine wondered if a smart bag could help. Over the space of several years, she built ten different prototypes using basic electronic kits, allowing her to explore lots of options. Her basic design has coloured lights on the outside of the bag, and a small scanner inside. To use the bag, you attach electronic tags to the things you don’t want to forget. They are like the ones shops use to keep track of stock and prevent shoplifting. Some tags are embedded into things like key fobs, while others can be stuck directly on to an object. Then when you pack your bag, you scan the objects with the reader as you put them in, and the lights show you they are definitely there. The different coloured lights allow you to create clear links – natural mappings – between the lights and the objects. For her own bag, Christine linked the blue light to a blue key fob with her keys, and the yellow light to her yellow hayfever tablet box.

In the wild

One of the strongest things about her work was she tested her bags extensively ‘in the wild’. She gave them to people who used them as part of their normal everyday life, asking them to report to her what did and didn’t work about them. This all fed in to the designs for subsequent bags and allowed her to learn what really mattered to make this kind of bag work for the people using it. One of the key things she discovered was that the technology needed to be completely simple to use. If it wasn’t both obvious how to use and quick and simple to do it wouldn’t be used.

Christine also used the bags herself, keeping a detailed diary of incidents related to the bags and their design. This is called ‘autoethnography’. She even used one bag as her own main bag for a year and a half, building it completely into her life, fixing problems as they arose. She took it to work, shopping, to coffee shops … wherever she went.

Suspicious?

When she had shown people her prototype bags, one of the common worries was that the electronics would look suspicious and be a problem when travelling. She set out to find out, taking her bag on journeys around the country, on trains and even to airports, travelling overseas on several occasions. There were no problems at all.

Fashion matters

As a bag is a personal item we carry around with us, it becomes part of our identity. She found that appropriate styling is, therefore, essential in this kind of wearable technology. There is no point making a smart bag that doesn’t fit the look that people want to carry around. This is a problem with a lot of today’s medical technology, for example. Objects that help with medical conditions: like diabetic monitors or drug pumps and even things as simple and useful as hearing aids or glasses, while ‘solving’ a problem, can lead to stigma if they look ugly. Fashion on the other hand does the opposite. It is all about being cool. Christine showed that by combining design of the technology with an understanding of fashion, her bags were seen as cool. Rather than designing just a single functional smart bag, ideally you need a range of bags, if the idea is to work for everyone.

Now, why don’t I have my glasses with me?

– Paul Curzon, Queen Mary University of London, Autumn 2018

Download Issue 25 of the cs4fn magazine “Technology Worn Out (and about) on Wearable Computing here.

Sick tattoos

Image by Anand Kumar from Pixabay

Researchers at MIT and Harvard have new skin in the game when it comes to monitoring people’s bodily health. They have developed a new wearable technology in the form of colour- and shape-changing tattoos. These tattoos work by using bio-sensitive inks, changing colour, fading away or appearing under different coloured illumination, depending on your body chemistry. They could, for example, change their colour, or shape as their parts fade away, depending on your blood glucose levels.

This kind of constantly on, constantly working body monitoring ensures that there is nothing to fall off, get broken or run out of power. That’s important in chronic conditions like diabetes where monitoring and controlling blood glucose levels is crucial to the person’s health. The project, called Dermal Abyss, brings together scientists and artists in a new way to create a data interface on your skin.

There are still lots of questions to answer, like how long will the tattoos last and would people be happy displaying their health status to anyone who catches a glimpse of their body art? How would you feel having your body stats displayed on your tats? It’s a future question for researchers to draw out the answer to.

– Peter W. McOwan, Queen Mary University of London, Autumn 2018

One in the eye for wearable tech

Contact lenses, normally used to simply, but usefully, correct people’s vision, could in the future do far more.

Tiny microelectronic circuits, antennae and sensors can now be fabricated and set in the plastic of contact lenses. Researchers are looking at the possibility of using such sensors to sample and transmit the glucose level in the eye moisture: useful information for diabetics. Others are looking at lenses that can change your focus, or even project data onto the lens, allowing new forms of augmented and virtual reality.

Conveniently, you can turn the frequent natural motion from the blinks of your eye into enough power to run the sensors and transmitter, doing away with the need for charging. All this means that smart contact lenses could be a real eye opener for wearable tech.

– Peter W. McOwan, Queen Mary University of London, Autumn 2018