towards enhancing communication between caregiver teams...

Towards Enhancing Communication Between Caregiver Teams andElderly Patients in Emergency Situations

Syed Atif Mehdi1, Artem Avtandilov1;2, Shah Rukh Humayoun2 and Karsten Berns1

1Robotics Research Lab, University of Kaiserslautern, Kaiserslautern, Germany2Computer Graphics and HCI Group, University of Kaiserslautern, Kaiserslautern, Germany

Keywords: Healthcare Robotics, Interacting Robots at Home, Graphical User Interfaces, Web-based Interaction, MobilePlatform, Evaluation Study.

Abstract: The paper presents a framework developed for facilitating care giver staff to interact with an elderly personin an emergency situation alone at home. The framework uses an autonomous mobile robot (ARTOS) as acommunication medium in the home environment to establish a communication channel. The novel idea inthis work is to facilitate emergency responding teams by also providing them access and control over the robotthrough mobile devices. The user evaluation study of the developed framework demonstrates the effectiveusability of the system even by users having no prior experience or training.

1 INTRODUCTION

The elderly population in developed countries issteadily increasing (Lehr, 2007). In many situationsthese people live alone in their homes and this re-quires urgent assistance in case of some emergencysituation happens to the person. Currently, many re-search groups are devoting their efforts in develop-ing robots that can perform several tasks in a typicalhome environment. They focus normally on perform-ing some activity in the home environment like fetch-ing objects (Graf et al., 2009), folding laundry (Cio-carlie et al., 2010), etc. In some cases, a robotic plat-form has also been used as a communication mediumbetween the elderly person and a family member ora caregiver staff (Merten et al., 2012; Rumeau et al.,2012). These robots can be more beneficial if theycan provide support to the health care staff when anemergency happens to an elderly person. One suchsupport would be to initiate the call to the health carestaff informing about the situation, other possibilitieswould be to allow the robot to be remotely controlledwithout the need of any sophisticated hardware (Dee-gan et al., 2008; Mehdi et al., 2014).

The main contribution of our current work is de-velopment of a framework for establishing communi-cation between the elderly person and the emergencyresponding teams via a mobile robotic platform andperforming evaluation studies describing the effec-tiveness of the developed approach. It is an exten-

sion to previously developed interfaces (Mehdi et al.,2014) where only staff at health care center was ableto communicate with the elderly person using the mo-bile robot as a platform.

In order to illustrate the concept and developedframework, this paper has been organized as fol-lows. Section 2 presents an overview of communi-cation mediums used during an emergency scenario.The framework developed for establishing commu-nication between the caregivers and the emergencyteams is described in Section 3. This section alsodescribes the communicating partners in detail. Sec-tion 4 describes the communication between the part-ners. Section 5 provides details of the conducted eval-uation studies as well as discusses the results. Finally,Section 6 provides the conclusion and gives directionsto the future work.

2 RELATED WORK

Crucial parts of the emergency response environmentsare interaction between different entities in the envi-ronment and the channels available for this interac-tion. Many emergency services around the world haveupgraded their hardware and software to meet the de-mand; however, vast majority of them still rely on thevoice communication solutions as a primary sourceof information when most up-to-date information is

118Atif Mehdi S., Avtandilov A., Rukh Humayoun S. and Berns K..Towards Enhancing Communication Between Caregiver Teams and Elderly Patients in Emergency Situations.DOI: 10.5220/0005492401180126In Proceedings of the 1st International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AgeingWell-2015), pages 118-126ISBN: 978-989-758-102-1Copyright c 2015 SCITEPRESS (Science and Technology Publications, Lda.)

required. Many previous works (Reddy et al., 2009;Paul et al., 2008; Kyng et al., 2006) have been tack-ling the issues in systematic approach to these frame-works.

Reddy et al. raised questions about the crisis man-agement and how technologies could affect the emer-gency services (Reddy et al., 2009). They concludedthat the teams of first responders and the service cen-ter have strong socio-technical aspect in interactionas well as pointing out that team-to-team and team-to-emergency sight communication are difficult to or-ganize. On the other hand, Paul et al. found the roleof technologies in the process as uncertain due to theopinion provided by the physicians participated in thestudy (Paul et al., 2008). While Kyng et al. tooka closer approach into how interactive such servicescould be, by setting specific challenges to the existingsystems handling emergencies (Kyng et al., 2006). Byillustrating the important role of the live video feedwhen handling an emergency, they provided sufficientproof that such solutions may be beneficial.

All the above-mentioned work took widely thetheoretic approach to the problem; however, most ofthe work providing the real communication and engi-neering solutions are developed in the industry tryingto meet market needs. Most pervasive approach inthe industry developed by Motorola1 provides a solu-tion for the emergencies occurring in largely accessi-ble public spaces, relies on the government’s accessto the CCTV recordings in real time, dedicated emer-gency channels and possibly a large impact. It aimsat improving response times, enhancing safety for re-sponders, and enabling better communication withemergency service center. This approach is basedon a steady ground of communication technologiesfinely tuned for the needs of first responders; how-ever, it lacks the individuality while tackling biggerproblems. As much as it is effective in the afore-mentioned type of emergencies, it lacks individual ap-proach when only one patient is endangered and doesnot provide interactive communication with the emer-gency scene.

Other solutions in the market like Mobile So-lutions2 and PK3 take another approach trying tostrengthen communication between different emer-gency services such as firefighters, medical personneland law enforcement by providing extended databasesupport with immediate access to records tacklingmostly management problems. Mobility for the com-mand center is showcased by PK. It could be installedon-site and serves as an authentication center and is-

1http://www.motorolasolutions.com2http://www.elliottmobilesolutions.com3http://www.pk.nl

sues tasks to all service members using hand-held de-vices.

As these industry approaches target communica-tion between the first responders and their commandcenters, they lack of the channels that are difficult toorganize (Kyng et al., 2006), namely live video feedfrom the place where emergency occurred when it isin the comfort of patients home. These communi-cation strategies consider facilitating interaction be-tween the diseased person and the service center. Al-though this is important but these do not provide anyframework for establishing communication betweenthe emergency responding team and the person in dis-tress, which could be helpful in better informing boththe team and the person.

3 METHODOLOGY

The main emphasis in this paper is to develop aframework for establishing communication channelbetween the Emergency Responding Team (ERT) andthe elderly person in an emergency situation at thehome environment. Since it is not known in advancewhich ERT will be able to reach the person at earli-est; therefore, the emergency situation is reported tothe Health Service Center (HSC). The HSC is thenresponsible to send the request to the ERTs and con-tact information is provided to only that ERT whichaccepts to undertake the responsibility. The respon-sible ERT can then communicate with the person us-ing the autonomous mobile robot as a platform andnavigate it in the home environment to understand thesituation. Figure 1 gives an overview of the completeframework.

3.1 Autonomous Mobile Robot

The Autonomous Robot for Transport and Service(ARTOS) (see Figure 2) has been developed at theRobotics Research Lab, University of Kaiserslauternin order to investigate challenges in providing to el-derly people living alone in their homes. The robotis capable of driving autonomously in the home en-vironment and detects obstacles using its laser scan-ner, ultrasonic sensors, and bumper sensor. It isalso capable of learning the daily routine of the per-son and searching the person using the learned rou-tine (Mehdi, 2014). The robot can also be tele-operated by caregiver staff at health service center us-ing a joystick in the Graphical User Interface (GUI) toobserve the home environment (Mehdi et al., 2014).

Towards�Enhancing�Communication�Between�Caregiver�Teams�and�Elderly�Patients�in�Emergency�Situations

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Figure 1: Overview of the developed framework.

Figure 2: Autonomous Robot for Transport and Service(ARTOS).

3.2 Health Service Center

The Health Service Center (HSC) is the first point ofcontact that receives the emergency help request fromARTOS. After receiving the request, they can tele-operate the robot to evaluate the situation in hand andverify any false alarm. The GUI (see Figure 3) at thecenter provides them with the view of the home usingcamera on the robot. After verification they can trans-fer the help request to the mobile teams to respond theemergency situation.

Figure 3: The GUI at HSC that visualizes the elderly per-son’s home environment and provides interactions to con-trol ARTOS and the camera.

3.3 Emergency Response Teams

Emergency Response Teams (ERTs) respond to theelderly person in an emergency situation. After re-ceiving the information from HSC, they can use AR-TOS as a communication medium to evaluate the sit-uation at home and to talk with the person in distress.

ICT4AgeingWell�2015�-�International�Conference�on�Information�and�Communication�Technologies�for�Ageing�Well�ande-Health

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4 COMMUNICATION BETWEENENTITIES

The emergency situation is notified by the ARTOSto the staff at HSC on their Graphical User Inter-faces (GUI). The notification contains the informationabout the person and the possible emergency situa-tion. The staff member at HSC can view the map ofthe home environment and the obstacles in the envi-ronment as detected by the sensors installed on therobot using the GUI. The staff member can also re-motely control the robot using the GUI to access thesituation and rectify in case a false alarm has beengenerated.

In case a valid emergency situation is recognized,the staff member at HSC can dispatch a message tonotify all the ERTs or the nearest ERT about the sit-uation. This is performed using the developed webserver running at the HSC. The web server commu-nicates with the Google Cloud Messaging (GCM)Services for dispatching the notification. The staffmember can also monitor the location of each ERTby tracking their GPS coordinates in the integratedGoogle Maps. The web server at the HSC han-dles communication, feedback, status updates anddatabase queries with the mobile application installedon the ERT mobile devices. It has been developed as amulti-user web-interface that can automatically prior-itizes lists of ERTs and pending emergencies, whichallows HSC staff to act effectively and can decreasetime needed to respond to an emergency request.

An Android application has been specifically de-veloped for the ERTs, to communicate with both HSCand ARTOS to receive most up-to-date informationabout the patient, their location, and the situationthat they are about to get involved. The function-ality of the application includes receiving live videoimage from ARTOS, joystick control of the robot toexplore the environment, status reports to the HSC,database access for extended information about thepatient, and navigation options. Figure 4 and Figure 5show screenshots of the developed mobile app for theERTs with the options of map selection and ARTOScontrol. The mobile app receives and interprets themessages received from the GCM. The message re-ceived contains information about the patient, addressand Skype id of ARTOS. The GUI of the applicationfacilitates the ERT in determining the acceptance orrejection of the job. In case of acceptance, it furtherreceives the information about the Skype id and IPaddress of the ARTOS. Once the vital information isreceived, ERT can directly communicate with the per-son in distress and does not require HSC, which sig-nificantly decreases the stressful job at HSC. Figure 6

Figure 4: A screenshot of the developed mobile app for theERTs that shows the availability of three maps, i.e., mapfor ARTOS location in the home environment, the homeenvironment 3D map, and the Google map to the elderlyperson home. Clicking on any of them shows in full screenthe selected map.

Figure 5: A screenshot of the developed mobile app for theERTs that shows the camera view of the ARTOS, while thejoy stick on the right side of the screen is used to control theARTOS movement.

Figure 6: Communication between the server at HSC andERT using Google Cloud Messaging. Once information isreceived by the ERT, they can directly communicate withARTOS using the developed Android App.

depicts the communication between ARTOS, HSCand ERTs.


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5 THE EVALUATION STUDIES

The main contribution of our framework is estab-lishing a communication platform between the healthcare staff at various levels (e.g., between the staff atHSC and the mobile response teams) and the elderlyperson at home. However, in our conducted evalu-ation studies we mainly focused on the mobile plat-form that we developed to be used by the mobileERTs.

We conducted the evaluation studies at two stages.The first evaluation study was carried out withthree usability experts using the heuristic evalua-tion (Nielsen and Molich, 1990; Nielsen, 1994) ap-proach. This evaluation ran on the first implementedprototype of the developed mobile app and the goalwas to find out the possible usability flaws in themobile app using the ten heuristics proposed byNielsen (Nielsen, 1994). Based on the results ofthis evaluation study by experts, we redesigned ourmobile app user interface and made the suggestedchanges.

The second evaluation study was conducted with10 participants having different background usingthe controlled task-based evaluation experiment ap-proach. They were also given closed-ended and open-ended questionnaires at the end of experiment in or-der to know their feedback. These participants weremostly researchers and students from the Universityof Kaiserslautern, as the goal of the second evalua-tion study was to analyze whether the developed mo-bile app (which will be eventually used by ERTs) iseasy to use without any prior training or expertise.

In the following subsections, we provide detailsof the conducted heuristic evaluation study followedby the user evaluation study in the controlled environ-ment.

5.1 The Heuristic Evaluation Study

The heuristic evaluation study was done with three us-ability researchers from the Computer Graphics andHCI group of the University of Kaiserslautern. Theyevaluated the first implemented prototype of the mo-bile app using the ten heuristics and ranked the userinterface giving a number from 0 to 4, where 0 meansno problem at all while 4 means usability catastro-phe (Nielsen, 1994). The goal was to find out usabil-ity issues in the early stage of the mobile app devel-opment in order to improve the design and UI basedon this evaluation.

A list of tasks were given to these experts con-sisted of the main features of the developed mobileapp: i.e., managing settings, performing status up-

dates, giving response to the emergency requests, es-tablishing Skype call with the patient, sending feed-back to the server, observing elderly person’s house-hold map, route planning with Google Maps, and con-trolling the ARTOS with joystick control option.

An introduction of the mobile app was given tothese experts before they started to evaluate it. Fur-ther, the task description from the users’ point of viewwas also given to them. They were also allowed to askdetails about any UI element or task during the evalu-ation. In order to maintain the settings, the same per-son was given the chance to explain the mobile appand tasks during the evaluation. A form was givento these experts in order to record their feedback re-garding the ten heuristics and their overall commentsregarding any particular task or UI element.

Figure 7 shows the feedback of these three expertsusing the ten heuristics, where the score indicates theaverage of their given ranking in all tasks. The feed-back indicated that some changes needed to be donefor preventing errors and extending the visibility ofthe system status. However, there was not any majorusability problem or usability catastrophe. The worstaverage grade of 2.0 from one expert was receivedin the category of help and documentation criteria.As our mobile app is intended to be used for pro-fessional purposes by ERTs, help and documentationmust be sufficient for users with any level of compe-tency and should provide in-depth review of the fea-tures. Other major issues were in the cases of fifth andninth heuristics (average score of 1.25 and 1.08 by allexperts, see Figure 7), which indicated insignificantlack of clarity on how to prevent and recover from er-rors.

These experts also gave their suggestions for im-proving the usability of the developed mobile app,e.g., to introduce status fields of the rescue team andthe current emergency. These suggestions were thenanalyzed and taken into account while developing thefinal version of the app.

5.2 The User Evaluation Study

The goal of this conducted user evaluation study wasto analyze whether the developed mobile app is easyto use without any prior training or expertise. There-fore, we were interested in finding out the effective-ness, efficiency, and user satisfaction aspects of ourdeveloped app, as it will be used by ERTs for com-municating with the HSC and the elderly person inthe emergency situation. The following metrics werederived from the GQM model (Basili et al., 1994).

� Metrics for effectiveness: We measure and com-pare the percentage of corrected completed tasks.


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0 0.5 1 1.5 2 2.5

1: Visibility of system status 2: Match between system and real world

3: User control and freedom 4: Consistency and standards

5: Error prevenCon 6: RecogniCon rather than recall 7: Flexibility and efficiency of use

8: AestheCc and minimalisCc design 9: Help users recover from errors

10: Help and documentaCon

Expert 1 Expert 2 Expert 3

Figure 7: Average score of the mobile app UI using the ten heuristics.

� Metrics for efficiency: We measure and comparethe time needed for completing each task.

� Metrics for user satisfaction: We collect partici-pants’ feedbacks and compare them.

We combined these metrics as suggested by theTechnology Acceptance Model (Venkatesh et al.,2003). For collecting the participants’ feedbacks onhow to improve the developed mobile app, we chosean open-ended questionnaire form in order to collecttheir comments. We formulated the set of hypothesesas:

� H1: We expect an effectiveness of more than90%, which means that in total participants accu-racy of the completed task would be at least 90%.

� H2: On average, both groups (i.e., the little orinexperienced group and the experienced group)achieve nearly the equal efficiency in completingthe given tasks.

� H3: Participants agree that the developed mobileapp is acceptable and useful for collaborating withHSC and ARTOS robot for handling the emer-gency request and for performing the rescue op-eration.

5.2.1 Study Design and Experiment Settings

Based on the identified goals and hypotheses, we de-signed this study as a controlled experiment underlaboratory conditions with a maximum time frame of45 minutes per participant. This allowed us enoughtime to have basic introduction explaining what is the

idea behind the developed mobile app and what kindof environment participants will be interacting with.

We ran the study with 10 participants (6 males, 4females), who were researchers and students from theUniversity of Kaiserslautern having different back-grounds. Only one of them had prior experience indealing with emergency situations. However, four ofthe participants had very little or no experience at allin using smartphones or smart tablets, while remain-ing six participants were experienced users of smart-phones. Further, four of the participants never had anyexperience of robotics while five of them had somebasic experience of robotics. The remaining one par-ticipant was an expert in robotics. The age range ofparticipants in this study was from 20 to 44 years witha median of 27.8 years old.

The participants were given four tasks to com-plete one by one. Completion of the tasks was timedand participants had a chance to ask questions dur-ing the experiment in case they run into some tech-nical difficulties or unable to complete the task bythemselves. An evaluator was there to carefully writedown the comments participants had upon comple-tion of each task in order to make sure that immedi-ate feedback is possible. After tasks were completed,participants were presented with two questionnairesforms: closed-ended questionnaires form and open-ended questionnaires form. The closed-ended ques-tionnaires form was based on nine questions, whereeach question offered a selection from six options ona Likert scale (Likert, 1932) (scale of 1 to 5 to showhow much participants agree with the given statementand an additional option “Don’t know”). The open-


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ended questionnaires form was aimed at general feed-back in which the participants were asked to list anypros and cons they have identified in the developedmobile app and an opportunity to voice any othercomments or suggestions.

The test was performed in the environment of thelaboratory, with the participants seated in an officechair with no table and the tablet was freely in theirhands. Participants were interacting with the mobileapp using the standard touch features with no prior ac-cess to the platform in order to ensure no prior trainingor familiarity with the features.

5.2.2 Tasks Description

The test consisted of the following four tasks:� Task 1: After an emergency request is issued:

find the basic information about the patient, planthe route to the patient home on the Google map,and accept the emergency request.

� Task 2: After an emergency request is issued: ini-tiate a Skype call and then decline the emergencyrequest.

� Task 3: After accepting an emergency request:open additional options for the emergency situa-tion, explore the map of the elderly patient house-hold, control the robot using the joystick, and nav-igate it to the patient.

� Task 4: As a team leader of the new started shift:enter your team details in the app settings and up-date the availability status.

5.2.3 Results and Discussions

In this subsection, we briefly discuss the results of thestudy. Overall, results of this conducted user evalua-tion study indicate satisfactory results in both groups.

From the effectiveness perspective, all of the par-ticipants were able to complete the tasks successfullyand accurately, which shows a high rate of effective-ness and proves that the developed mobile app is easyto operate. This also proves our hypothesis H1 inwhich we were expecting that on average participantswould be able to accurately complete the tasks at least90% of the total tasks.

The results from the efficiency perspective (i.e.,the time completion) are listed in Figure 8, whichshows the average time completion per task for theboth groups (i.e., little or inexperienced users and ex-perienced users). Participants from both groups donot show any significant differences in time complet-ing any of the tasks. This demonstrates that the de-veloped mobile app is easy to use and does not re-quire much experience in order to complete the task.

The main task (i.e., Task 3) that took most of the timewas navigating the robot using the joystick and thisis natural due to the speed of ARTOS. This bringsus to the importance of the closed-ended question-naires (see Table 1) and open-ended feedback fromthe participants. Even though most of the participantsagreed that “It was easy to handle the robot with thejoystick”, the average grade of 3.8 is the lowest com-paring to other features used in the developed mo-bile app. This was due to the security features of therobot navigation system and participants’ unfamiliar-ity with the environment. In the real life scenarios,trouble of making yourself familiar with a new envi-ronment could facilitate emergency response team’sactions when they arrive to the endangered person’shouse and when time matters the most. Overall, theresults shown in Figure 8 prove our hypothesis H2, inwhich we were expecting nearly the equal efficiencyfrom the participants with little or no experience com-pared to the experienced participants.

0 20 40 60 80 100 120 140 160

Task 1

Task 2

Task 3

Task 4

Li/le or no experience Experienced

Figure 8: Average time completion in seconds of partici-pants in both groups.

When we look at the participants’ feedback inthe closed-ended questionnaires (see Table 1), we ob-serve an average score of more than 4 in most of thecases, which shows high acceptance ratio of our mo-bile app amongst the participants. However, in ques-tion 3 (regarding the handling of robot through joy-stick) and question 4 (recovering from mistakes) wesee a lower score. As described above, the first rea-son was in difficulty of handling the ARTOS while inthe second case few of the participants were unfamil-iar with the Android platform that allows users to goback to the previous stage through the Back naviga-tion button. Overall, the results of participants in theclosed-ended questionnaires also prove our hypothe-sis H3, in which we were expecting a high acceptanceratio from the participants.

Further, the feedback provided by the open-endedquestionnaires reveals the particular features of themobile app participants were or were not satisfiedwith. The open-ended questionnaires were built


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1 2 3 4 5 N/A Median

1: It was easy to see the current status of the system 0 1 1 5 3 0 4

2: It was easy to change Team availability status 0 1 2 0 7 0 4.3

3: It was easy to handle the robot with the joysBck 0 2 2 4 2 0 3.8

4: It was easy to recover from mistakes 0 0 3 3 2 2 3.9

5: I found it easy to locate the needed features in the layout of the app 1 0 1 4 4 0 4

6: It was easy to complete provided tasks 0 1 0 3 6 0 4.4

7: It was clear from the icons the intended features they represent 0 0 1 2 7 0 4.6

8: I found the interface easy to use 0 0 1 6 3 0 4.2

9: I would recommend to use this system for emergency scenarios regularly 0 0 0 4 4 2 4.5

Table 1: Participants’ feedback in closed-ended questionnaires form. Here, 1 means “strongly disagree” and 5 means “stronglyagree”. The last column shows average score of all participants.

around the idea that the participant will give somebasic feedback upon completion of every task andthe evaluator will write it down, and after the par-ticipant completes all of the tasks he/she will be al-lowed to list pros and cons of the mobile app as wellas giving any other general feedback. The collectedopen-ended feedback showed participants’ appreci-ation towards the clarity in the GUI’s visualization,namely the icons that were always reflecting the fea-ture underneath it. They were also sharing their pos-itive experience on how the interface was clear andreflecting the purpose of the mobile app. Amongthe cons participants were listing lack of the sourcefor help when something was unclear and noting thatthey were ready to operate the robot if it was mov-ing around faster; therefore, saying that it was a littleslower than they expected. One of the other commonfeedback responses was initial confusion with the login mechanism for the team. Participants expected tobe allowed to put their personal details in the mo-bile app, while they actually only needed to pick theiridentification (the badge number) to log in, which wasspecifically implemented to reduce time it takes to login and avoid possible typos when entering the details.

6 CONCLUSIONS

This paper has demonstrated the use of a frame-work that can facilitate communication channel be-tween an elderly person in emergency situation at ahome environment, health service center and emer-gency responding teams. The autonomous mobile

robot, AROTS, provides the channel for establishingthis communication. The possibility of remotely con-trolling ARTOS to analyze the situation by movingthe robot to different rooms and observe the imagessent by the robot, enriches the user experience.

In the future, we plan to perform detailed evalua-tion studies in real environment settings to check thefeasibility and effectiveness of the complete frame-work. Further, we also intend to develop a communi-cation channel between different emergency respond-ing teams in order to provide a better collaborationbetween these teams to tackle the emergency situationmore effectively.

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