Health and Human Services

Advances in information and communications technologies (ICT) will transform the delivery of essential health, education and other human services in powerful ways – and smart cities will ride the wave to ensure a better life for their residents.

Let’s imagine Los Angeles in the year 2030. An ill student is home in bed, following her algebra instructor’s lesson over her smartphone. The instructor asks the class to solve for X, and our student raises her hand miles away to solve the equation in real time. Later that night, through an app on the same phone, she downloads her algebra homework assignment and in a virtual classroom she and her fellow students work together to apply the day’s lessons.

She finishes her homework and opens up a new app – one that transmits data from her ongoing radiology treatment to her specialist in New York. She uses the mobile medical devices her hospital supplied and sends her health update off in a matter of minutes. Downstairs, her mother is online accessing her daughter’s medical records through the same portal that she has used to receive job training and employment referrals.

Welcome to the future of health and human services delivery, enabled by cloud-based apps, wearable devices, telepresence, robotics and other advanced technologies that will help smart cities improve the well-being of their citizens.

But before we dive too far into this chapter, let’s deal with some definitions. In the Readiness Guide we consider human services those that cities provide to support the well-being of residents – their health and welfare,their education, the clean air they breathe and even the food they eat. Whereas in previous chapters we showed how ICT makes infrastructure smarter, in this chapter we explore how ICT empowers people to be smarter and healthier. The importance of smart human services can’t be overstated – after all, an educated and healthy city is a wealthy and successful city.

Making health and human services delivery smarter

There are four inter-related areas in health and human services where ICT can substantially improve services for city residents. Because some elements of those services are not owned by cities, the effort will require participation with public and private organizations.

  1. Public health is the macro, citywide view of health. Epidemiology, air quality, UV radiation, health research and development, population health management, food safety, health literacy and other large-scale issues are the concern of city public health agencies. Smart public health uses ICT to improve outcomes for citizens and cities alike. City agencies can use sensors to collect data on air quality, noise pollution, UV radiation, diseases and a host of other factors that impact public well-being. They can also proactively receive health information directly from citizens, by encouraging them to share their health feedback and experiences through mobile apps. This data can then be analyzed to detect trends and potential problems – and to inform city decision-making – which might include anything from zoning laws to emission standards to mobilizing health providers to respond to an outbreak.
  2. Health services are how cities support the mental and physical well-being of residents. Traditional approaches to health care are being challenged by several factors that seriously strain tight city budgets:

 • Non-communicable diseases such as heart disease, diabetes, obesity, stress and mental health problems have grown significantly in the last decade, and are often concentrated in urban areas.

• Many regions of the world have inadequate health services that are unable to keep up with demand from growing populations, particularly as people age – and live longer.

• Urban populations continue to swell around the globe; over half of all people now live in cities and the trend is expected to continue.

The emerging discipline of smarter healthcare – sometimes referred to as e-health or e-Care – uses technology to overcome these chal- lenges (and greatly improve outcomes) in these ways:

• It broadens and deepens access to health services.

• It addresses health factors holistically, across a broader range of city services and departments, and by focusing on prevention and healthier living.

• It supports better cooperation, collaboration and productivity between multidisciplinary and often geo-dispersed teams of health professionals.

Remote delivery of health services (as you’ll read about in case studies later in this chapter) makes it possible for a patient to receive advice and treatment from a doctor without having to leave home or work. And the doctor can assess and treat conditions in real time and with maximum efficiency. This is one example of how smart cities use ICT to improve health – reaching more people in less time and using fewer resources without compromising the quality of health outcomes.

Here’s another: Health care providers are rapidly ditching paper-based patient medical records for electronic health records (EHRs). A doctor enters the exam room, chats with the patient and conducts an exam. The doctor then turns to a keyboard to enter data into fields on a computer screen. The patient’s health profile gets electronically updated right then and there.

There’s a big upside to having this digital version of a person’s medical history. It makes their diagnoses, lab tests, allergies, current prescriptions and other bits of health information easy to share and manage. It allows for coordination of their care between clinicians. It helps control the administrative cost of delivering care. All of these are essentials in smart healthcare and certainly in smart cities that are proactive about enhancing livability for their residents.

Additionally, natural user interfaces and analytics can “learn” about a patient’s health history and suggest tailored and specific medical interventions.

There’s also the convenience factor. A mother gets a text on her smartphone that it’s time for her child’s vaccination; she can make the appointment on her phone or on a web portal. In so many ways, information can be a powerful tool in healthcare – and ICT can help get it to the people who need it, when they need it.

  1. Human services refer to a broad spectrum of easily accessed services that help people live better lives. These include services to help people deal with substance abuse, domestic violence, HIV/AIDS, disabilities, nutrition challenges and physical fitness. It includes helping the homeless find beds to sleep in and dysfunctional families find counseling.

While it is common for cities to treat health and human services separately, smart cities integrate a client’s human services history into their health portfolio for better outcomes and greater efficiency.

  1. Education and skill development are a priority in a smart city. They provide opportunities for all ages and all levels, ranging from toddler story hours at the public library to computer classes at the senior center. K-12 education, workforce training programs and higher education are all essential. But today education is mostly stuck in the physical world. With the right deployment of ICT, cities can revolutionize the connection between student and teacher, school and learning.

Dependencies in health and human services

When planning improvements in the public health arena, it’s important for cities to recognize dependencies between healthcare services and other city systems and services.

Clearly, public healthcare services rely heavily on a city’s public safety, communications and water systems. One example: The health of a city’s population is at risk if municipal water supplies are contaminated.

On the human services front, consider the dependencies between education and communications, energy systems and government administrative services. For instance, enhancing communications technologies and access to them can help conquer the “digital divide” that challenges low-income students. The same communications technologies can improve access to remote education services.

Benefits of health and human services

Before we examine this chapter’s targets in detail, consider how smart health and human services enhance livability, workability and sustainability.  

 Livability

Improving patient satisfaction. One of the primary benefits of remote delivery of heatlhcare services – or telemedicine – is increased patient satisfaction, especially for the elderly and mobility-challenged, but others too. Imagine if instead of taking time off work, making a trip to the doctor’s office and then sitting in a waiting room, you could transmit your health data on your own time, and your physician could review it with you via a video feed. Telemedicine eliminates much of the hassle associated with healthcare.

A prime example of how well telemedicine can work is the field of telepsychiatry. A psychiatrist is able, through video technology, to examine a patient in much the same way an office examination would take place. The psychiatrist can interview the patient, examine his or her overall appearance and check for symptoms of problems.

As beneficial as telemedicine can be, it must be noted that there remain barriers to its adoption – regulatory and insurance roadblocks among them.

Improving the delivery of health, education and other human services. City services are often under-utilized because those most in need of them may not know they are available, aren’t sure they qualify, or don’t know how to access them. An integrated, personalized citizen portal ensures easy, on-demand access to information people need.

Ensuring better, faster response to public health emergencies. The combination of smart devices, advanced and predictive analytics – even social media – empower public health officials like never before. They can monitor the outbreak of a disease or a hazardous fuel spill in real time, predict how it will spread and alert the public instantly through a wide range of communications channels.

Providing more access to healthcare – and better disease prevention. Cities are growing larger. And as they grow, existing medical resources are not always keeping pace, which means access to them becomes more difficult. How can ICT help cities bridge the gap between growing demand and available resources? By creating targeted prevention campaigns that reach residents and encourage them to act. It can also help the medical community care for more patients with better results.

Workability

Improved public health means fewer work hours missed. A 2012 study estimated that illness cost the United States economy around $576 billion a year. Cities that use ICT to bolster awareness of public health issues and promote remedies optimize their citizens’ well-being, which translates into a more productive workforce and a stronger economy as a result.

Smart education makes a city more attractive to business and talent. Cities that make education a priority and use technology to empower current and future workers with a superior education and continuing online education and training – particularly in high-demand fields such as math, science and technology – can capitalize on this demand to draw new businesses and investment that bolsters the local economy.

Smart healthcare and social services make a city more attractive to business and talent too. Cities that offer access to state-of-the-art healthcare and social service programs have a competitive advantage in attracting the creative class of tomorrow. Put simply, if you’re a top talent, you’re not going to locate your family somewhere they’d have to leave when they needed quality health and human services.

Sustainability

Telemedicine is cost effective. Because of its capabilities, telemedicine can help cities provide quality care with fewer resources.

Long-term healthcare costs drop. Intelligent devices that measure and track health conditions can help public health officials prepare targeted prevention campaigns where they are most needed throughout a city. Successful campaigns can result in lower overall healthcare costs.

Smart learning means less travel. Improved service delivery of educational opportunities utilizing ICT cuts down on travel, which promotes energy conservation.

Health and human services targets

As you’ll see in the pages that follow, there are two targets specific to this health and human services chapter and they will be discussed in detail. We’ll also explain how other universal targets apply to health and human services.

Instrumentation and control

Health and human services use instrumentation and control in two slightly different ways, but the primary mission remains the same as in other city responsibility areas. It’s all about data collection.

Implement optimal devices and other instrumentation for each human service. Implementing the right data-capturing devices across all of a city’s health and human services responsibility areas is the objective here. Given the new and different types of services involved, different kinds of instrumentation will be required.

For instance in a smart city, instrumentation can include smartphones and apps that allow people to directly participate in city public health and human services monitoring by providing feedback about conditions and experiences. For example, Council Partner IBM has created the Accessible Way app that allows users to report on the accessibility of their cities, and in doing so help construct a crowd-sourced knowledge base about urban mobility challenges.

In the healthcare, social services and education arenas, devices collect data from people for the most part. These include devices that may monitor how patients in a study are responding to a new medication or ones that record academic progress in a new teacher’s classroom. The purpose is to provide actionable data that can be analyzed for trends or problems.

Data-capturing devices are critical for the telemedicine systems mentioned earlier. Patients use devices to acquire data on their health status in the comfort of their homes and then transmit it to remote care providers. This greater efficiency can save time, money and resources. Similar savings can occur when health professionals remotely monitor patients with chronic conditions like diabetes or heart disease. And the opportunity to use ICT for real-time, interactive checkups allows physicians to deliver emergency medical help that can save lives where more time-consuming traditional medicine may be too late.

In education, there are many ways to improve outcomes through ICT. Applying data analytics to test results, attendance and graduation rates can help pinpoint problems and trends. Today’s smart devices combined with all manner of web apps and social media tools connect students to teachers, to other students and to diverse learning opportunities in ways never imagined a few short years ago. In one example, school-owned smartphones that allowed a 24/7 wireless connection to teachers improved algebra proficiency results by 30%

Privacy and security

While technologies drive the growth of convenient new products and services, those same technologies have raised privacy concerns in many areas. It is critically important that citizens are able to trust that the information they share with programs and services via smartphones, social media and the like – and particularly potentially sensitive personal information – remain private.

To drive that point home, a TRUSTe survey found only 20% of participants believed the benefits of their smart devices were more important to them than their personal privacy. In other words, the great majority thought their privacy was more important than the convenience of their smart devices.

The security recommendations that follow offer a common sense approach to resolving privacy issues.

Publish privacy rules. Smart cities should let residents know what they are doing to protect their privacy.

Create a security framework. A smart risk mitigation strategy designed to identify and deal with threats will give cities the tools to prevent security breaches.

Combat cybersecurity threats. Security professionals have warned of a dramatic rise in the number of cyber attacks against critical infrastructure – ranging from electric grids and the transportation system to hospitals and other providers of key services. Implementing a cybersecurity network as soon as possible will enhance the safety of personal information – and reduce its cost.

Take precautions to protect patient and student data. Remove personally identifying information from data that is to be stored in the cloud to protect their privacy if the data is stolen or compromised.

These steps will not only provide protections for sensitive personal information, they also will go a long way toward minimizing privacy concerns residents may have about using relatively new services such as telemedicine and other advanced ICT-based technologies that may not be new, but are unfamiliar to residents asked to use them.

By taking these steps, cities will do much to assuage potential privacy concerns that could become a barrier to telemedicine or other advances in health and human services technologies designed to help them.

Connectivity

We talked earlier about how public health agencies use smart devices and other instrumentation to collect data about air quality, disease outbreaks and the like. Collecting it is only a starting place.

Connect devices with citywide, multi-service communications. Connecting the smart devices deployed around cities for public health data-capture to a citywide communications system is important for realizing improved public health outcomes in the same way that smart gas or water meters must be connected to optimize those infrastructures. Water quality monitors that detect a chemical leak that could contaminate a popular swimming beach isn’t useful unless the information is communicated in real time to all of the city departments that might need to get involved.

Data management

To reinforce the privacy and security strategies highlighted in the previous section, smart cities will want to make sure all departments are following the same rules.

Create and adhere to a citywide data management, transparency and sharing policy. Again, due to the sensitive nature of data involving health and human services, it goes without saying that a policy needs to be very explicit about who owns which data sets, who has access, how it can be shared and when it should not be shared.

When cities adopt an open data policy for non-sensitive information, they unleash enormous possibilities. In conjunction with a strong and clear privacy policy, city health and human services data can be used to create new health, social services and education apps –an easy win for cities and residents.

Architect a single health history for citizens. As we mentioned earlier, smart cities integrate personal health data from their different agencies and departments so that patients can enjoy the benefits of a single health history. This repository can be more than passive storage – it can be an online, security-enhanced storage, sharing and services platform that citizens can access.

Computing resources

There’s nowhere in a smart city that computing resources aren’t a major player. Below is a quick refresher on four targets to consider in a health and human services context.

Consider a cloud computing framework. Cloud computing has become more affordable and more prevalent. Smart cities of all sizes may see advantages in the cloud’s scalability, reliability and cost. However, as we mentioned earlier, before uploading personally identifiable health and human services data to the cloud, steps must be taken to “de-identify” it.

Use an open innovation platform.

An open innovation platform empowers innovators. And the possibilities in the health and human services arena are limitless. In New York City, for example, residents can download an app that provides all sorts of useful information about local restaurants – including what grade they received in their most recent health inspections.

 

Adhere to open standards (and help develop them). A number of information technology standards organizations have health working groups and a few standards groups are dedicated to efficient communication in the health industry. Health-related standards are still emerging, and cities have a stake in their outcome. Groups welcome their participation.

Have access to a central GIS. With health and human service agencies spread out in many parts of a city, a GIS will prove useful for smart cities. A central GIS enables efficiency gains through more intelligent scheduling and routing, provides improved accuracy of essential records and boosts resiliency of key assets.

Have access to comprehensive device management. It’s important to include devices used by health and human services workers in the field – smartphones, laptops, etc. – as part of a city’s device management system to ensure they comply with city data management, security and privacy policies.

Analytics

While the Watson supercomputer became a household word after its appearances on TV quiz show Jeopardy!, Council member IBM didn’t build it to be a novelty or high-tech curiosity. Far from it. Watson and its cognitive computing technology have been put to work in a variety of industries, from kitchens to hospitals. In a pilot program with the U.S. Department of Veterans Affairs (VA), Watson is sifting through millions of pages of patient records and medical literature to identify better and faster ways to treat the overwhelming number of war veterans who return home with post traumatic stress disorder (PTSD).

The four targets highlighted here demonstrate how analytics are particularly important as cities monitor trends and developments in public health.

Achieve full situational awareness. Smart cities use monitoring devices to take the pulse of the city and its people. Situational awareness aids that effort by increasing the reliability and resiliency of the public health infrastructure and those monitoring devices, allowing for quick response to incidents that threaten public health and well-being. Situational awareness depends on different systems being able to communicate about “where” and “when.” Thus open standards for encoding, discovering, assessing and using spatial and temporal data play a key role in health and human services analytics applications

Achieve operational optimization. Analytics help cities ensure the best possible public health outcomes. For example, they may reveal a sudden shift in air quality in a particular part of a city that requires corrective action. Or analysis of health records may reveal an abnormally high number of lung cancer cases in a community, prompting an investigation by public health officials.

Achieve asset optimization. The objective here is to ensure maximum value is extracted from a city’s investments in health and human services infrastructure – which includes everything from computers in offices to field devices that monitor things like water quality at public beaches. Calculating precisely which assets should be replaced or repaired and when helps achieve maximum return on investment.

Pursue predictive analytics. Analyzing health and human services data to spot patterns and

trends and take action before situations worsen can make a city more livable. By monitoring the path and characteristics of a virus, for instance, public health officials can predict where it will strike next and alert residents how they can protect themselves.

As we’ve said, predictive analytics can also help people understand what their own health might look like in the future, offering incentive for behavior changes.

ISO 37120: A yardstick for measuring city performance

In 2014, the International Organization for Standards announced an ISO standard that applies strictly to city performance. The document -- known as ISO 37120:2014 -- establishes a set of open data indicators to measure the delivery of city services and quality of life. It defines common methodologies that cities can use to measure their performance in areas such as energy, emergency response, transportation and more.

In the ISO 37120 tables we have indicated how the standards correspond to Education and Health relate to the Council’s Health and Human Services targets identified in the table following these indicators. Environment and Recreation Indicators are that are part of the standard are highlighted on the next page.

It could be argued that the education theme is perhaps the most important of the 17 indicators in that education is essential to human development. Education powers scientific advancement and economic development, enables people to provide for themselves and their families, and allows for individual enrichment and personal growth.

Health Indicators

Implement optimal instrumentation

Citywide, multi-service communications

De-identify patient data for research in cloud

Architect single health history for citizens

De-identify student data for research in cloud

Create citywide data management policy

Have access to central GIS

Pursue predictive analytics

Achieve full situational analysis

Core

12.1 Average life expectancy

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12.2 Number of in-patient hospital beds per 100,000 population

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12.3 Number of physicians per 100,000 population

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12.4 Under age five mortality per 1,000 live births

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Supporting

12.5 Number of nursing and midwifery personnel per 100,000 population

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12.6 Number of mental health practitioners per 100,000 population

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12.7 Suicide rate per 100,000 population

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Education Indicators

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6.1 Percentage of female school-aged population enrolled in schools

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6.2 Percentage of students completing primary education: survival rate

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6.3 Percentage of students completing secondary education: survival rate

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6.4 Primary education student/teacher ratio

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Supporting

6.5 Percentage of male school-aged population enrolled in schools

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6.6 Percentage of school-aged population enrolled in schools

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6.7 Number of higher education degrees per 100,000 population

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The health theme measures key health indicators including life expectancy, a city’s healthcare delivery system and its citizens’ mental health. Businesses and residents generally want to locate in areas with a high quality of life -- and the health indicators included in ISO 37120 reflect key elements of a city’s quality of life.

The environment theme’s primary focus is air quality. The World Health Organization estimates that outdoor air pollution caused 3.7 million premature deaths worldwide in 2012.

““We change what we measure – and so it’s a good thing when cities carefully and persistently measure what’s in the air their residents breathe and the water they drink,” says Bill McKibben, a noted author, environmentalist and founder of 350.org. “High standards help keep cities in the forefront of the environmental fight.”

The recreation theme measures a city’s indoor and outdoor recreational space. As technology industry veteran George Karayannis wrote in the series on ISO 37120 he wrote for the Council: “Recreational space is not only key to a city’s livability, it is an essential element of public health and, when properly maintained, provides significant economic benefits for both residents and cities. Public green spaces can be especially useful in combating heat island effects in cities, reducing air and water pollution and minimizing storm water runoff issues.”

Environment Indicators

Implement optimal instrumentation

Citywide, multi-service communications

De-identify patient data for research in cloud

Architect single health history for citizens

Achieve operational optimization

Create citywide data management policy

Have access to central GIS

Pursue predictive analytics

Achieve full situational analysis

Core

8.1 Fine particulate matter (PM2.5) concentration

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8.2 Particulate matter (PM10) concentration

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8.3 Greenhouse gas emissions measured in tons per capita

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Supporting

8.4 NO2 (nitrogen dioxide) concentration

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8.5 SO2 (sulphur dioxide) concentration

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O3 (Ozone) concentration

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8.7 Noise pollution

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Recreation Indicators

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13.1 Square meters of public indoor recreation space per capita          

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13.2 Square meters of public outdoor recreation space per capita          

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Health and Human Services Targets

In the checklist below, targets specifically pertaining to the health and human services responsibility are in bold, universal targets are not. 

TECHNOLOGY

Enabler Health and Human Services Targets

How smart cities deploy and use ICT to enhance health and human services

Implementation Progress

NonePartialOver 50%Complete

Instrumentation & Control

Implement optimal instrumentation

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Connectivity

Connect devices with citywide, multi-service communications

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Interoperability

Adhere to open standards

Use open integration architectures and loosely coupled interfaces

Prioritize use of legacy investments

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Security & Privacy

Publish privacy rules

Create a security framework

Implement cybersecurity

De-identify patient and student data for storage and research in the cloud

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Data Management

Create a citywide data management, transparency and sharing policy

Architect a single health history for citizens

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Computing Resources

Consider a cloud computing framework

Use an open innovation platform

Have access to a central GIS

Have access to comprehensive device management

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Analytics

Achieve full situational awareness

Achieve operational optimization

Achieve asset optimization

Pursue predictive analytics

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ADDITIONAL RESOURCES

Target: Implement optimal instrumentation
Air quality agency automates permitting; higher efficiency leads to better air quality
Bay Area Air Quality Management District regulates air pollution in the San Francisco area. Regulatory oversight for a diverse set of 25,000 businesses requires the district to make its business processes smart, efficient and automated. It worked with Council member Microsoft to implement a foundation for an automated, online permitting and inspection system.
 
Target: Create a security framework
Nurses on the go: Moving sensitive information securely from remote locations
Visiting Nurse Service of New York (VNSNY) is dedicated to home and community-based healthcare. It has approximately 18,000 employees, including nurses and other healthcare professionals who use tablets to record information from their home health visits. Realizing it needed a way to securely transfer data, including patient health information, to company systems, VNSNY implemented WebSphere MQ software from Council member IBM.
 
Target: Connect devices with citywide, multi-service communications
8 Essentials for Mobile Learning Success in Education
This white paper suggests best practices and proven solutions to address the most common challenges related to mobile learning, based on experiences from Council member Qualcomm’s robust Wireless Reach education portfolio which takes advanced wireless technologies to underserved communities around the world.
 
Smart Terminals Bring the Whole Hospital to the Point of Care
Hospitals are under pressure to find ways to achieve greater operating efficiency to reduce costs. The “smart” bedside terminal addresses these challenges. This all-in-one device connects and integrates the hospital information network, clinical services and patient entertainment and communication systems, enabling better and more efficient access at the point of care. Read more in this case study from Council member Intel.
 
Target: Use an open innovation platform
Ooredoo App combats High Infant and Maternal Mortality Rates in Myanmar
Citing infant and maternal mortality rates that are significantly higher in Myanmar than in neighboring countries, Council member Ooredoo launched a free app that gives pregnant women and new mothers instant access to health information.
Stephen Hawking and the Intel Connected Wheelchair Project
In the Connected Wheelchair Project, Intel’s Internet of Things group uses the Intel® Galileo board to help Dr. Stephen Hawking and others with disabilities seamlessly interact and analyze their health, wheelchair and accessibility. This video shows the proof of concept being built and includes Dr. Hawking discussing the technology’s impact.