The rise of self-service social care

Imagine you’ve been asked to think up a really difficult technical challenge. Well how about delivering health and social care on line, using self-service portals, to frail and elderly citizens?

For good measure, imagine that those people need your services to be as simple and familiar as Amazon or Google and that the people funding you are Local Authorities, facing budget cuts in the order of 60%. Oh and you have to ensure accessibility – from PCs, tablets, mobile phones, and smart TVs and support off-line working in rural communities. It could be described as a perfect storm.

Care Act banner

To encapsulate the challenge, the Association of Directors of Adult Social Services, ADASS, has published a paper on “the development of online services for information and advice supporting the Care Act 2014″, which gives an excellent overview.

Self-service has to succeed

We need to succeed with this challenge if we are to enable individuals, and their carers or agents, to help themselves to plan for and obtain timely care, mainly through resources in the community and care suppliers. Those with high needs will be able to use tools to support a dialogue with the council around self-assessment and start the process towards council funding or applying for care accounts.

The reality is that only self-service will allow citizens to continue to receive quality support with all the well versed pressure on health and social care budgets – our aging society and the increase in administrative duties on Councils brought about by the Care Act, estimated at a 60% increase, on average, per Council.

The paper highlights that, where a person applies for council services or a care account, the information should transfer to the council’s back office system through an “open API“. This is vital, if we are to avoid the age old dilemma of people filling in information online but then have to tell their story over and again to different professionals. It also discusses the Government Digital Service principles behind good design of websites. For example, there has been a tendency to use pictures to make social care sites feel friendly but the paper points to modern research that shows this does not work.

The potential savings of self-service portals have been analysed by Socitm who have shown the relative costs of different forms of contact:

  • On-line information contacts cost £0.09
  • Telephone contacts cost £2.59
  • Face to face contacts cost £8.15

It’s a massive difference, and one that could mean millions of pounds of cost, or savings, depending on how councils choose to approach this challenge in the next few years.

How can self-service make a real difference, both for stretched Local Authorities and Citizens?

One example is triage using our Online Financial Assessment tools – with simplified needs and financial assessment questionnaires to help people see whether they are likely to be funding themselves or whether they might qualify for supported care.

Another example is for council IT systems such as ContrOCC to accept online self-referrals from citizens, completing as much workflow as possible before handing it over to the council.

The paper also makes reference to OCC’s work on micro commissioning or mini-tendering, where authorities are enhancing their directories so that they can send out a package of needs and ask suppliers to come back with priced offers to meet them.

The paper makes a number of references to our work at CarePlace and one to East Sussex 1Space. Not many other eMarketPlaces get a mention so we are really proud to see the collaborations we have with our customers clearly at the forefront of the challenge.

The key to building innovation

Jeff Gothelf is the author of Lean UX, a book that plugs into the theory of The Lean Startup and looks at how User Experience design processes fit in with the Lean approach.

Jeff was interviewed by Communitech News and described what he believes is the key to building an innovative product or company:

Talk to your customers.

I mean, really have the humility to listen to your customers.

Learn what it is that they love about your product; learn what it is that they hate about your product; learn about what it is that they hate about your competitor’s product; learn about what they love about your competitor’s product.

Listen to them and their needs. Figure out what job they are hiring your product to do, and then make your product do that better than anyone else’s. You will never know that unless you leave the safety and comfort of your office and go out and talk to your customers.

That really inspires me.

I recommend the rest of the interview too, where Jeff discusses the importance of cross-functional teams, mistakes to avoid, and how to remain competitive as you scale your product.

National Grid showcasing three OCC-partnered projects at LCNI

National Grid will be showcasing three of their OCC-partnered projects at the Low Carbon Networks & Innovation Conference (LCNI) in Aberdeen, 20-22 October 2014. The conference is a platform for gas and electricity network operators to showcase projects sponsored under their NIA and NIC innovation schemes.

The OCC-partnered projects are:

  • Ramp Rate Study System: an interface to a numerical modelling tool that allows engineers to study the effects of a sudden change in gas pressure (“ramping”) on the network.
  • Standards Map: allows engineers to see and navigate the thousands of dependencies between National Grid’s technical standards documents.
  • Network Investment Storyboard: an offline GIS tool which allows the presentation and exploration of different investment options in a clear and consistent manner.

At this event, National Grid Gas Transmission will be presenting key innovation projects from their NIA portfolio on the exhibition floor with guest speakers presenting at several breakout sessions. National Grid are taking this opportunity to promote their valuable project collaboration and partnerships (OCC being one) that consistently contribute to the successful delivery of their innovation portfolio. James Whiteford of National Grid will be the guest speaker on Day 2 of LCNI and will present the Network Investment Storyboard. A video of the tool is available on request.

The Standards Map features in the annual summary of Network Innovation Allowance, on page 10. This tool shows the complex dependency network between the standards National Grid have to maintain.

Standards Map

Innovation at National Grid

National Grid is actively involved in supporting innovation projects via its NIA funding mechanism. You can also read a summary of the Gas Transmission project portfolio. You’re welcome to visit the National Grid exhibition stand at the LCNI conference where OCC’s projects will be amongst the highlighted works.

ASP.NET Web API on Linux and Apache with Mono

We had a requirement at OCC to build a RESTful web service that would be able to run on both Windows and Linux servers. Someone suggested we give Mono a look to see if we would be able to use the ASP.NET Web API framework served up by the Apache Web Server on Linux. That sounded great; we have a lot of experience with the .NET Framework and a lot of experience with Linux but so far have not brought the two together.

Banner showing Mono, .NET, ASP.NET, Apache and Linux logos

Mono is an implementation of the .NET framework that can be used to build applications that run on Linux and OS X in addition to Microsoft Windows. There are further details on Wikipedia.

In the past, some concerns have been expressed regarding licensing, software patents and their possible impact on Mono and the applications that depend upon it. The Mono team have addressed these concerns and recently (April 2014) Microsoft released Roslyn under the Apache 2 license and have committed to working closely with the Xamarin team, whose product is based around Mono, which may further calm concerns.

Getting Started on Linux

If you are lucky your system will have a package available to install Mono, if so then you should use this. At the time I was not so lucky so had to get the latest stable source and build that.

In Practice

Because the Mono team are attempting to keep up with developments by Microsoft the Mono framework does not fully implement the latest .NET framework. This can lead to some headaches where there is a partial implementation which can result in some methods of a class not being available under Mono but often these issues can be worked around.

However, Mono is under very active development and generally manages to keep up surprisingly well.

Pros:

  • Can use Visual Studio for the bulk of development.
  • Once something builds and runs on Windows it runs very reliably on Mono. I’ve only been looking at Web applications so I couldn’t comment on a Desktop application with a GUI.

Cons:

  • NuGet has limited usefulness with Mono. I had to get the necessary binary files and manage a Libraries directory within the project. Not a big issue in my case but could be if large numbers of externals are required.
  • Have to maintain a separate build on the Linux system. I used makefiles which was not too onerous but this might be mitigated by MonoDevelop or Eclipse but it did not seem enough of a problem.

Building Mono

Building Mono from source is pretty straightforward but there are a few gotchas.

First it is necessary to make sure a basic development environment is in place, on a CentOS system that’s something along the lines of:

    yum -y install bison glib2 glib2 freetype freetype-devel \
        fontconfig fontconfig-devel libpng libpng-devel libX11 \
        libX11-devel glib2-devel libgdi* libexif glibc-devel \
        urw-fonts java unzip gcc gcc-c++ automake autoconf \
        libtool wget giflib-devel libjpeg-devel libtiff-devel \
        libexif-devel httpd-devel

Source Code

Get the 2.10 source releases of [libgdiplus][15], [mod_mono][16] and [XSP][14] – at the time of writing the stable build of mono is at version 3.2.3. It is does not appear to be important to have all components with the same version as the main Mono release.

Unpack each in a local directory then configure and build in the following order:

libgdiplus

    cd libgdiplus-2.10
    ./configure --prefix=/opt/mono
    make
    sudo make install

Mono

    cd mono-3.2.3
    ./configure --prefix=/opt/mono --with-libgdiplus=/opt/mono
    make
    sudo make install

Add the /opt/mono/bin path to the system path and also set the PKG_CONFIG_PATH to /opt/mono/lib/pkgconfig through the /etc/profile (do not forget to export the variables). These variables must be set before building xsp as it needs the C# compiler otherwise the configure part of the build will fail.

xsp

    cd xsp-2.10
    ./configure --prefix=/opt/mono
    make
    sudo make install

mod_mono

    cd mod_mono-2.10
    ./configure --prefix=/opt/mono --with-mono-prefix=/opt/mono
    make
    sudo make install
    sudo mv /etc/httpd/conf/mod_mono.conf /etc/httpd/conf.d/

Configuration

It will probably be necessary to add the path to Mono’s shared libraries to the system wide library path. This can be done by either adding the path to /etc/ld.so.conf or, if the /etc/ld.so.conf.d directory exists, by adding a new file there (I suggest following the naming convention used by other files in that directory) with the path to the Mono shared libraries – these will be at /opt/mono/lib. Once this has been done run the ldconfig command as root to update the system.

After building and installing check the installation by running:

    mono-test-install

Making .NET 4.5 work

When building from source code there is a problem when running applications which require the .NET framework 4.5 libraries. The xsp4 and mod_mono shell scripts that are executed (located in the /opt/mono/bin directory) refer to executables in the /opt/mono/lib/mono/4.0 directory. Typically the executables themselves are fine but they refer to the 4.0 libraries which can be missing some of the newer features. This can result in problems of the form:

    Exception caught during reading the configuration file:
    System.MissingMethodException: Method not found: blah blah blah
      at System.Configuration.ClientConfigurationSystem.System..... yack yack

To fix this first make symbolic links in the 4.5 directory to the 4.0 files:

    ln -s /opt/mono/lib/mono/4.0/xsp4.exe /opt/mono/lib/mono/4.5/xsp4.exe
    ln -s /opt/mono/lib/mono/4.0/mod-mono-server4.exe \
        /opt/mono/lib/mono/4.5/mod-mono-server4.exe

Then edit /opt/mono/bin/xsp4 and /opt/mono/bin/mod-mono-server4 to reference the symbolic links.

Fixing errors caused by colons in the virtual path name

In our application the resources managed by the RESTful interface include the colon ‘:’ character. There appears to be a bug which creeps out when using ASP.NET applications in sub directories. The problem appears with the static initialisation in System.Web.VirtualPathUtility which manages to not read the Web.config system.web/monoSettings verificationCompatibility="1" attribute so fixed by setting the monoSettingsVerifyCompatibility member variable false otherwise errors are generated when there is a colon in a virtual path name.

Apache

The Apache mod for Mono passes requests to the mod_mono_server, which is able to support multiple ASP.NET processes.

With the above completed restart Apache web server and verify that mod_mono has been picked up.

    httpd -M

You can also inspect the error log after a restart.

MonoServerPath

Mono’s support for ASP.NET under Apache uses a simple module which delegates requests to the mod-mono-server. The MonoServerPath setting in httpd.conf specifies where the mono server is for each location:

    MonoServerPath default "/opt/mono/bin/mod-mono-server4" 

This configures mono for the default path which for a standard Apache configuration will be /var/www/html. It is also necessary to configure the application and handler:

    MonoApplications "/:/var/www/html"

    <Location "/">
        Allow from all
        Order allow,deny
        SetHandler mono
    </Location>

In addition, the following options can be set:

    MonoSetEnv default MONO_IOMAP=all
    MonoDebug default true

Restart the server and check the error log file.

If other locations need to be configured much the same needs to be repeated, for example, if a /test application were to be created it would be configured as:

    Alias /test "/var/www/test"
    MonoServerPath test "/opt/mono/bin/mod-mono-server4"
    AddMonoApplications test "/test:/var/www/test"

    <Location "/test">
        Allow from all
        Order allow,deny
        MonoSetServerAlias test
        SetHandler mono
    </Location>

Other Directives

It is recommended to disable KeepAlive for performance reasons or at least restrict the time-out to 2 seconds.

    KeepAlive Off

The CentOS installation of Apache web server sets the name for the log files as access_log and error_log; you may want to have the more conventional .log file extension.

Configuration Tool

The mono site has a handy online tool that can help with setting up a basic configuration for either a virtual host or an application.

In conclusion

Building a RESTful ASP.NET Web API with Mono, to run on Windows and Linux servers, was pretty straightforward with only a few problems on the way.

Digital Health Hackday

David Hannaford and Mark Stone attended Digital Health Oxford’s Hackday, held at the Oxford Launchpad in Said Business School, Oxford, over the weekend of 12th and 13th July.

David’s team came 2nd for the data visualization tool they built to enable a doctor to show a patient their survival rate if they are at risk from cardiac issues. The app calculates the survival rate of an individual by looking at data on risk factors, such as age, weight, blood pressure, and whether the patient is a smoker or diabetic.

Screenshot of the app

The technologies used to create the app are JavaScript, jQuery and D3 (D3 is a data visualization JavaScript library).

20140713_140748

David having fun trying out Google Glass

This hackday had a focus on Global Health, Patient Experience, Care, Aging, and Management in Medicine. There was also a  Clinicians’ Challenge and Patients’ Challenge, although participants were free to decide what they’d like to work on. There were mentors to help advise and guide, and an expert panel to judge the projects at the end.

Digital Health Hackdays are weekend events that bring together researchers, developers, clinicians, entrepreneurs, patients, engineers, designers and others interested in Digital Health.

CuPiD demo at Said Business School

Reynold Greenlaw and Andy Muddiman attended the Oxford Startups demo night at Oxford Launchpad in the Said Business School, on 15th May where they demoed the GaitAssist smartphone app that has been developed for the Cupid project. They demoed it pretty much continuously at our very busy table to the many interested attendees and our communications manager Janine Smith joined in to lend a hand.

The app continuously compares the gait of a user with Parkinson’s disease during walking with an “optimal gait” calibrated with a clinician. Based on evaluation of the specific patient, the most important gait parameters (e.g. step length, cadence) are set for future training sessions. The app gives the user feedback on how well they are doing and uses a technique to help Parkinson’s gait called audio cueing.

Cupid demo 3  Cupid demo 1Andy and Reynold demoing the app

Data on gait performance is visible to the clinician who can then adjust the exercise remotely forming a feedback loop between the user and the doctor. You can take a look at the demo itself on this video of Audio Bio-Feedback in action.

This event was organized by the Oxford Academic Health Science Network which brings together clinicians, academics and the public to promote best health in the region.

The Oxford Launchpad was launched in February 2014. It is a new space for entrepreneurial activity housed within the Said Business School, University of Oxford.

EmerGent: Relevance of Social Media in Emergencies

We recently started a new project – EmerGent, which is a 3 year European project researching the impact of social media by emergency services during a crisis.

Emergent logo

Whenever there’s a large fire, riot, earthquake or other crisis a lot of information immediately appears in social media – some valuable, some completely erroneous. With our partners we are developing tools and techniques for mining and validating that content.

The EU-FP7 EmerGent project has received funding from the European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreement no 608352. Find out more about EmerGent and its partners on the project website.

Finding time to think

A personal blog post from our Director of Consultancy Projects

As well as delivering products, OCC has a team that specialises in custom software development; they are behind the wide variety of case studies on our website. This combination of teams working on custom software and product development & support is, I think, unique.

Once a year I take the custom development team out for a day to discuss how we might write even better software. This time we crossed the road to the Jam Factory for an open discussion and some prepared talks. The talks were:

  • A toolkit for establishing better experience for our users
  • The judicious use of Agile project management
  • A critical look at SOLID principles
  • Lessons on testing from the product development team

The result was a surprise to me. The conclusion of the team was that best way to improve our performance was none of the above but instead improving the office environment. Nothing to do with software at all. The team wanted fewer interruptions, less multitasking  and more time to quietly think through difficult technical problems.

I was surprised and really interested in the conclusion. Our office is already considered calm and quiet. So we’re going to try a few new things. We’re going to experiment with collaboration tools that allow people to raise a “Do not disturb” flag. We’re using instant messaging that reduces disruption, hosted within OCC to keep the data confidential. I’m encouraging staff to book rooms or work from home during intensive design phases. It’s going to be interesting to see how we get on.

Consultancy Away Day

Consultancy Away Day

The OCC Christmas party, in May, in Poland

For our 2013 Christmas do we decided we would visit our colleagues in Poland rather than go for the usual Christmas outing. As Poland tends to be rather chilly in December we opted to hold out until May and hope for some summery weather.

So, over a long weekend, we (along with friends and partners) enjoyed the delights of a boat trip, a visit to underground cellars where vodka is made and aged, a walk round a picturesque lake, two lovely dinners, one in a Pomeranian Castle, and also a lively paintball game.

We didn’t have any snow as might normally befit a Christmas trip – the first day was very beautifully sunny and the second very wet, when we had to shelter under a bridge to have our picnic.

OCC has been running a small office in Szczecin for many years and some of our Polish engineers are now experts in UK social care.

CuPiD Technical Workshop

We believe there are many organisations implementing systems that conform to the following pattern:

  • A patient is being supported at home.
  • They wear sensors and/or use a smartphone.
  • Sometimes there is a home unit that wirelessly connects to the sensors/smartphone.
  • The data is securely transferred to a server.
  • There is a browser based application by which a clinician accesses the data.
  • Sometimes the clinician can send data back to the patient via the home unit or smartphone.
  • There may be integration between the server and external systems such as EHR.

We are holding a technical workshop at our offices in the centre of Oxford on the 14th April and inviting projects building similar systems to attend.

We will demonstrate the Cupid system and exercises, and talk openly about what went well and what didn’t. We will also discuss our plans to provide the telemedicine on an open source basis after at the completion of the Cupid project. The Cupid system is nearly complete.

CuPiD Exergaming The workshop will be an open discussion for a technical audience to exchange ideas and information. There will be time to talk about the validating and exploiting telemedicine systems. Please note this is not a marketing or sales event, but an opportunity to network.

So far we have representatives from StrokeBack, CogWatch, Oxford University, Oxford Brookes Movement Science Group and Digital Health Oxford attending.

If you would like to come please contact info@oxfordcc.co.uk