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 Cathy Bodine
Sumi Helal
Tao Gu
Mounir Mokhtari (Eds.)
LNCS 8456

Smart Homes
and Health Telematics
12th International Conference, ICOST 2014
Denver, CO, USA, June 25–27, 2014
Revised Papers

123
Lecture Notes in Computer Science 8456
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University of Surrey, Guildford, UK
Jon M. Kleinberg
Cornell University, Ithaca, NY, USA
Friedemann Mattern
ETH Zurich, Zürich, Switzerland
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Stanford University, Stanford, CA, USA
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Weizmann Institute of Science, Rehovot, Israel
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Indian Institute of Technology, Madras, India
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TU Dortmund University, Dortmund, Germany
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University of California, Los Angeles, CA, USA
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University of California, Berkeley, CA, USA
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Max Planck Institute for Informatics, Saarbruecken, Germany
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Cathy Bodine Sumi Helal
•

Tao Gu Mounir Mokhtari (Eds.)

•

Smart Homes
and Health Telematics
12th International Conference, ICOST 2014
Denver, CO, USA, June 25–27, 2014
Revised Papers

123
Editors
Cathy Bodine Tao Gu
University of Colorado RMIT University
Denver, CO Melbourne, VIC
USA Australia
Sumi Helal Mounir Mokhtari
University of Florida CNRS IPAL (UMI 2955)
Gainesville, FL Singapore
USA Singapore
and
Institut Mines-Télécom
France

ISSN 0302-9743 ISSN 1611-3349 (electronic)

Lecture Notes in Computer Science
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 Preface

It is our great pleasure to welcome you to Denver, Colorado, and to the 12th Inter-
national Conference on Smart Homes and Health Telematics – ICOST 2014. This year
the ICOST program offered exciting and high-quality sessions, including six technical
sessions, a poster session, three keynotes from highly recognized researchers and
visionary leaders in the industry in addition to two panels.
In addition to the technical program, an exciting social program was planned for all
registrants. A welcome reception followed by a Gala Dinner kick-started our social
program at the Denver Museum of Nature and Science on June 25. An evening of
entertainment was also planned at the Denver Center for the Performing Arts, down-
town Denver. Together, we enjoyed a sneak peek into the rehearsal process conducted
by the Phamaly Theatre Company, as well as enjoyed musical pieces from the popular
musical Joseph and the Amazing Technicolor Dreamcoat.
Putting together ICOST 2014 was a team effort. We would like to first thank the
authors for submitting their best work and providing the content of the program in
terms of papers and posters. We would also like to thank the panelists and the three
keynote speakers for their contributions. We are grateful to the Organizing Committee
and its dedication in making ICOST 2014 a success. Mounir Mokhtari provided
invaluable guidance which was very helpful throughout the process. Tao Gu did a great
job in assembling a world-class Program Committee for soliciting and reviewing the
papers. Carl Chang did a great job guiding the process of forming the two panels in the
program. Bessam Abdulrazzak did a great job with the conference publicity and for that
we are very grateful. We also thank Elizabeth Woodruff for helping in many admin-
istrative and local arrangement issues.
Now we cannot forget to thank our sponsors: the Department of Bioengineering at
the University of Colorado, Assistive Technology Partners at the Medical School,
University of Colorado, the Coleman Institute for Cognitive Disabilities, the University
of Florida, and the Institut Mines-Télécom, France. Their sponsorship and support were
vital for the successful organization of this conference.
We wish you all a pleasant stay in Denver, and a memorable and rich experience in
ICOST.

June 2014 Cathy Bodine

Sumi Helal
 ICOST 2014 Organization

Organizing Committee
General Chair
Cathy Bodine University of Colorado, Denver, USA

General Co-chair
Sumi Helal University of Florida, USA

Program Chair
Tao Gu RMIT University, Australia

Finance Co-chairs
Katherine Hoch University of Colorado, Denver, USA
Jit Biswas Institute for Infocomm Research, Singapore

Publicity Chairs
Bessam Abdulrazzak Université de Sherbrooke, Canada

Publications Chair
Mounir Mokhtari Institut Mines-Télécom, France

Local Organization Chair

Elizabeth Woodruff University of Colorado, Denver, USA

International Liaison Chair

Daqing Zhang Institut Mines-Télécom, France

Panels Chair
Carl Chang Iowa State University, USA

Scientific Committee
Bessam Abdulrazak Université de Sherbrooke, Canada
Z. Zenn Bien Korea Advanced Institute of Science
and Technology, South Korea
Carl K. Chang Iowa State University, USA
Sylvain Giroux Université de Sherbrooke, Canada
VIII ICOST 2014 Organization

Sumi Helal University of Florida, USA

Nick Hine University of Dundee, UK
Ismail Khalil Johannes Kepler University of Linz, Austria
Yeunsook Lee Yonsei University/The Korean Gerontological
Society, South Korea
Mounir Mokhtari Institut Mines-Télécom, France/CNRS and Image
& Pervasive Access Lab, Singapore
Chris Nugent University of Ulster, UK
Tatsuya Yamazaki NICT, Japan
Daqing Zhang Institut Mines-Télécom/Telecom SudParis, France
Cristiano Paggetti I+ S.r.l, Italy
William Cheng-Chung Chu Tunghai University, Taiwan

Program Committee
Yves Demazeau CNRS – Laboratoire LIG, France
Bin Guo Telecom SudParis, France
Laurent Billonnet University of Limoges, France
Lyes Khoukhi University of Technology of Troyes, France
Margaret Hamilton RMIT University, Australia
Jayachandran Maniyeri Institute for Infocomm Research, Singapore
Nirmalya Roy University of Maryland, Baltimore County, USA
Manfred Wojciechowski Fraunhofer ISST, Germany
Daqing Zhang Institut Mines-Télécom/Telecom SudParis, France
Jeffrey Soar University of Southern Queensland, Australia
Joo-Hwee Lim PI2R, A*STAR, Singapore
Hongbo Ni Northwestern Polytechnical University, China
Duckki Lee LG Electronics, South Korea
Hamdi Aloulou Image & Pervasive Access Lab, Singapore
Fulvio Mastrogiovanni University of Genoa, Italy
Natalia Díaz Rodríguez Åbo Akademi University, TUCS, Finland
Amee Morgans Monash University, Australia
Hyun Kim ETRI, South Korea
Zhixian Yan Samsung Research America, USA
Fabrice Peyrard IRIT, France
Jit Biswas Institute for Infocomm Research, Singapore
Zhiwen Yu Northwestern Polytechnical University, China
Venet Osmani CREATE-NET, Italy
Xianping Tao Nanjing University, China
Johnny Wong Iowa State University, USA
Abdallah M’Hamed Telecom SudParis, France
Arkady Zaslavsky CSIRO, Australia
Thibaut Tiberghien Image & Pervasive Access Lab, UMI CNRS,
Singapore
Ye-Qiong Song LORIA – University of Lorraine, France
 ICOST 2014 Organization IX

Mathieu Raynal IRIT – University of Toulouse, France

Charles Gouin-Vallerand Télé-Université du Québec, Canada
Nadine Vigouroux IRIT, Université Paul Sabatier, France

Sponsored By
Keynotes
 A New IT (Inclusive Technology) Revolution

Frances W. West
IBM, One Rogers Street, Cambridge, MA 02142, USA

Abstract. With more than one billion people with disabilities worldwide, in
addition to the aging population, novice technology users, people with
language, learning and literacy challenges, or any individual facing a
situational impairment while using a device, the global demand for accessi-
bility has made it a mainstream requirement for governments and businesses
around the globe. And, the success of trends such as mobile, social, smart TVs,
wearable devices and cognitive technologies will depend on the ongoing
integration of adaptive, intuitive and accessible technology capabilities. This
means that CIOs and IT leaders need to provide technology solutions to reduce
barriers for people with disabilities and realize that these same accessible
technologies can increase productivity and improve the overall user experience
for the mass market. Attendees will learn how next generation solutions
are complementing and supplementing the human senses to better optimize
communications and make information more meaningful and consumable to
everyone.

Short Biography

Frances West is the worldwide director of the IBM Human

Ability and Accessibility Center (HA&AC), a division of IBM
Research. In this position, she advances IBM market leadership
by driving technology innovation and solution development in
the area of human ability and accessibility. Prior to her current
assignment, Frances was director of Channels, Alliances and
Business Development for IBM Lotus Software, where she
recruited and managed IBM’s global network of Business
Partners specializing in Lotus software.
Frances joined IBM in 1979. Between 1979 and 1998, she held numerous
management positions across the IBM sales and marketing organizations. In 1998,
Frances became the Business Unit Executive of the Banking, Financial Services,
Securities and Insurance Unit for the IBM Greater China Group. The following year,
she was named the Director of Financial Services Sector Solutions for IBM Global
Services, where she managed investment funding and executed financial services
solution plans for ban king, insurance and financial markets. Since joining IBM
Research to lead the HA&AC in 2003, Frances has become a globally-recognized
expert in enabling human ability through accessible information and communications
technology (ICT). She has served on the Board of Directors for numerous advocacy
XIV F.W. West

organizations, including the American Association of People with Disabilities, the

Assistive Technology Industry Association and the U.S. Business Leadership Network
(USBLN). She currently sits on the Board of Directors of the World Institute on
Disability, is the board advisor to the National Business & Disability Council, and
Founding member and Program Co-Chair of G3ict, an advocacy initiative launched by
the United Nations Global Alliance for ICT and development in 2006.
Frances has become a sought after authority on the topic of global ICT
accessibility trends and enablement. In 2010, she delivered remarks at policy forums
hosted by the United Nation’s Global Initiative for Inclusive Information and
Communications Technologies; a U.S. Department of Labor, Office of Disability
Employment Policy roundtable; and an international forum hosted by the São Paulo
State Secretariat for the Rights of Persons with Disabilities in Brazil. Most recently, in
November 2013, she testified on behalf of the IT industry to the U.S. Senate
Committee on Foreign Relations in support of the ratification of the Convention on the
Rights of Persons with Disabilities. Frances attended the Chinese University of Hong
Kong, Washington & Lee University in Virginia and graduated with a marketing
degree from the University of Kentucky. In 2011, she received an Honorary Doctor of
Science degree from the University of Massachusetts Boston. Frances is married with
two sons and currently resides in West Newton Hill, Mass.
 10 Years of Reminding Technologies:
What Have We Learnt?

Chris Nugent
Computer Science Research Institute, School of Computing and Mathematics,
University of Ulster, Rm 16J20, Jordanstown Campus,
Shore Rd., Newtownabbey, County Antrim, BT37 0QB, UK
[email protected]

Abstract. People with mild dementia generally exhibit impairments of

memory, reasoning and thought. As a result, they require varying levels of
support to complete everyday activities to maintain a level of independence.
The use of technological solutions to address such impairments have been
recognized as being capable of providing a positive impact on the quality of life
for both the patient and their carer. Specifically, the integration of cognitive
prosthetics, technology based solutions to augment reminding functionality,
into everyday lives of people with dementia has been shown to be a popular
approach. This presentation will reflect upon the journey of the development
and evaluation of cognitive prosthetics over the last 10 years, highlighting
lessons which have been learnt. This will involve considering, through the use
of a range of Case Studies, the evolution of cognitive prosthetics from a device
perspective, the impact of adopting a user centred iterative design process,
through to more recent efforts of aligning solutions with everyday technolog-
ical platforms. The presentation will conclude by considering future trends,
most notably highlighting user profiling in an effort to improve technology
adoption.

Short Biography

Chris received a Bachelor of Engineering in Electronic

Systems and DPhil in Biomedical Engineering both from the
University of Ulster. He currently holds the position of
Professor of Biomedical Engineering at the University.
His research within biomedical engineering addresses the
themes of the development and evaluation of Technologies to
support ambient assisted living. Specifically, this has involved
research in the topics of mobile based reminding solutions,
activity recognition and prompting, formats for data storage
and more recently technology adoption modeling. He has published extensively in
these areas with the work spanning theoretical, clinical and biomedical engineering
domains.
XVI C. Nugent

He has been a grant holder of Research Projects funded by National, European

and International funding bodies. Amongst these projects he was the Scientific
co-ordinator of the European Union MEDICATE consortium, Technical co-ordinator
of the European Union CogKnow consortium and Technical co-ordinator of the ESRC
New Dynamics of Aging Well Consortium.
At present he is Group Leader of the Smart Environments Research Group which
was established in 2009 and is co-PI of the Connected Health Innovation Centre at the
University of Ulster. He currently holds the position of Visiting Professor of Mobile
and Pervasive Computing at Lulea Technical University, Sweden.
 The Challenge of Assistive Technologies
in Developing Countries

Michael Lightner
Department of Electrical, Computer, and Energy Engineering,
University of Colorado – Boulder, Engineering Center,
Rm ECEE1B55, 425 UCB, Boulder, CO 80309-0425, USA
[email protected]

Abstract. The challenge of providing assistive technology (AT) to people with

disabilities is one that is becoming a mainstream concern as presented in the
keynote by Frances West and supported by specific case studies presented in
the keynote by Chris Nugent. In this talk we address the challenges of
providing these supports in developing countries. Most of the world’s 1 billion
people with disabilities do not live in the developed world, simply because
most of the world’s population is not in developed countries. Yet our
technological solutions often require an infrastructure that is missing in villages
with little or no electricity, where family units are the only support for those
with disabilities, with schools having little effective infrastructure, where
mainstreaming has never been heard of and where there are no support
agencies. In this talk we will begin with a review of the demographics and
associated economics of the developed and developing world. Then we will
compare a number of ATs and their appropriateness in a variety of developing
world situations. Examples of AT that are effective will be presented. The
lesson is that there is a spectrum of technical sophistication in AT and this
spectrum needs to be supported in order to span developing and developed
countries. Some suggestions for understanding the ecosystem of AT and how
that maps to developing countries will be presented. We will close with an
example of a sophisticated solution to a simple, but difficult, problem and how
a social entrepreneurship start-up is helping to bring this to developing
countries.

Short Biography

Michael Lightner is Professor and Chair of Electrical, Computer

and Energy Engineering at the University of Colorado, Boulder.
He received his PhD from Carnegie-Mellon. He is Co-Director
of the NIDRR funded Rehabilitation Engineering Research
Center for Adv ancing Cognitive Technologies at the University
of Colorado Health Sciences Center and Technology Director of
Boulder Digital Works, an innovate postgraduate digital media
XVIII M. Lightner

program. He has also served as Associate Dean for Academic Affairs for the College
of Engineering and Applied Science.
For many years his research was focused on electronic design automation
including simulation, synthesis, test, formal verification and optimization. He has also
worked in signal processing, most recently on multi-rate adaptive filters. The last ten
years have been spent focusing on AT for people with cognitive disabilities. In this
capacity he helped found and was Associate Executive Director of the University of
Colorado Coleman Institute for Cognitive Disabilities, founded with a $250M gift
from Bill and Claudia Coleman.
In these recent roles he has worked with a variety of government agencies and
NGOs, and initiated the first IEEE Conference on the Future of Assistive Technology
bringing together government, academia, industry, NGOs, public interest groups and
the public to address the needs in AT over the next decade. He was made a Fellow
of the IEEE for his contribution to computer-aided design. He is also a Fellow of the
American Institute for Medical and Biological Engineering. Through his various roles
in the IEEE, including 2006 President and CEO, and 2012–2013 Vice President for
Education Activities, he has presented talks on Cognitive Assistive Technology in
multiple locations in India, China, Africa, Indonesia, the EU and the USA. He has
interacted with technology leaders in India on how cell phones can effectively be used
in villages with little or no electricity.
 Contents

Design and Usability

Designing a Multi-sided Health and Wellbeing Platform:

Results of a First Design Cycle. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
W.J.W. Keijzer-Broers, G.A. de Reuver, and N.A. Guldemond

Design and Usability of a Smart Home Sensor Data User Interface

for a Clinical and Research Audience . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Mary Sheahen and Marjorie Skubic

EasiSocial: An Innovative Way of Increasing Adoption of Social Media

in Older People. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Kyle Boyd, Chris Nugent, Mark Donnelly, Roy Sterritt, Raymond Bond,
and Lorraine Lavery-Bowen

Agile Development for the Creation of Proper Human-Computer Interfaces

for the Elderly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Drew Williams, Mong-Te Wang, Chih-Hung Chang, Sheikh Iqbal Ahamed,
and William Chu

Assistive and Sentient Environments

Testing Real-Time In-Home Fall Alerts with Embedded Depth

Video Hyperlink . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Erik E. Stone and Marjorie Skubic

ShowMeHow: Using Smart, Interactive Tutorials in Elderly Software

Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Drew Williams, Mong-Te Wang, Chih-Hung Chang, Sheikh Iqbal Ahamed,
and William Chu

Actimetry@home: Actimetric Tele-surveillance and Tailored to the Signal

Data Compression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Jacques Demongeot, Olivier Hansen, Ali Hamie, Hana Hazgui, Gilles Virone,
and Nicolas Vuillerme

Monitoring Patient Recovery Using Wireless Physiotherapy Devices . . . . . . . 71

Nirmalya Roy and Brooks Reed Kindle
XX Contents

Cognitive Technology

Comparison of Two Prompting Methods in Guiding People with Traumatic

Brain Injury in Cooking Tasks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Jing Wang, Harshal Mahajan, Pamela Toto, Ashlee McKeon,
Michael McCue, and Dan Ding

A Collaborative Patient-Carer Interface for Generating Home Based Rules

for Self-Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Mark Beattie, Josef Hallberg, Chris Nugent, Kare Synnes, Ian Cleland,
and Sungyoung Lee

Measuring the Impact of ICTs on the Quality of Life of Ageing People

with Mild Dementia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Mounir Mokhtari, Romain Endelin, Hamdi Aloulou, and Thibaut Tiberghien

VA SmartHome for Veterans with TBI: Implementation

in Community Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
Kristina M. Martinez, Karen M. Mann, Christina Dillahunt-Aspillaga,
Jan M. Jasiewicz, Deborah Rugs, Yorick Wilks, and Steven G. Scott

Activity Recognition

Regression Analysis for Gesture Recognition Using RFID Technology . . . . . 121

Kevin Bouchard, Bruno Bouchard, and Abdenour Bouzouane

Improving Activity Recognition in Smart Environments

with Ontological Modeling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Zachary Wemlinger and Lawrence Holder

Remote Monitoring Using Smartphone Based Plantar Pressure Sensors:

Unimodal and Multimodal Activity Detection . . . . . . . . . . . . . . . . . . . . . . . 138
Ferdaus Kawsar, Sheikh Ahamed, and Richard Love

Mining for Patterns of Behaviour in Children with Autism Through

Smartphone Technology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
William Burns, Mark Donnelly, and Nichola Booth

Context and Situation Awareness

Ontology Based Context Fusion for Behavior Analysis and Prediction . . . . . . 157
Asad Masood Khattak, Amjad Usman, and Sungyoung Lee

Quantifying Semantic Proximity Between Contexts . . . . . . . . . . . . . . . . . . . 165

Patrice Roy, Bessam Abdulrazak, and Yacine Belala
 Contents XXI

Emotion Aware System for the Elderly . . . . . . . . . . . . . . . . . . . . . . . . . . . 175

Hai Yu, Celine Maria Amrita Anthony Sunderraj, Carl K. Chang,
and Johnny Wong

Health IT

Dual Locks: Partial Sharing of Health Documents in Cloud . . . . . . . . . . . . . 187

Mahmood Ahmad, Zeeshan Pervez, and Sungyoung Lee

Biomedical Ontology Matching as a Service. . . . . . . . . . . . . . . . . . . . . . . . 195

Muhammad Bilal Amin, Mahmood Ahmad, Wajahat Ali Khan,
and Sungyoung Lee

Short Contributions

Action Prediction in Smart Home Based on Reinforcement Learning . . . . . . . 207

Marwa Hassan and Mirna Atieh

A Mobile Survey Tool for Smoking Dependency Among Native Americans . . . 213
Golam Mushih Tanimul Ahsan, Drew Williams, Ivor D. Addo,
S. Iqbal Ahamed, Daniel Petereit, Linda Burhansstipanov,
Linda U. Krebs, and Mark Dignan

Smart Built Environments and Independent Living: A Public

Health Perspective. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
Blaine Reeder, George Demiris, and Hilaire J. Thompson

iCanLearn: A Mobile Application for Creating Flashcards and Social Stories™

for Children with Autism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
Aaron Zaffke, Niharika Jain, Norah Johnson, Mohammad Arif Ul Alam,
Marta Magiera, and Sheikh Iqbal Ahamed

A Comparison Between Ambient Assisted Living Systems. . . . . . . . . . . . . . 231

Molham Darwish, Eric Senn, Christophe Lohr, and Yvon Kermarrec

Access My Campus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238

Kevin Michael Amaral, Ping Chen, William S. Carter, and John Sanchez

Immersive Physiotherapy: Challenges for Smart Living Environments

and Inclusive Communities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242
Nirmalya Roy and Christine Julien

Evaluation of the Barthel Index Presented on Paper and Developed Digitally . . . 249
Elizabeth Sarah Martin, Chris Nugent, Raymond Bond, and Suzanne Martin
XXII Contents

CALONIS: An Artificial Companion Within a Smart Home for the Care

of Cognitively Impaired Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
Yorick Wilks, Jan M. Jasiewicz, Roberta Catizone, Lucian Galescu,
Kristina M. Martinez, and Deborah Rugs

Author Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261

Design and Usability
 Designing a Multi-sided Health and Wellbeing
Platform: Results of a First Design Cycle

W.J.W. Keijzer-Broers1(&), G.A. de Reuver1, and N.A. Guldemond2

1
Delft University of Technology, Delft, The Netherlands
{w.j.w.keijzer-broers,g.a.dereuver}@tudelft.nl
2
UMC Utrecht, Utrecht, The Netherlands
[email protected]

Abstract. While worldwide several health and wellbeing products and services
are being developed to support people to live comfortable and independently in
their home environment, widespread adoption of these smart living solutions is
still not envisioned. A hindering factor is that users are not aware of possible
solutions or where to find them, which could be solved through promoting
solutions on shared platforms. Designing such platforms is challenging as
multiple stakeholders need to be satisfied and start-up problems need to be
overcome. Most theory on platforms is explored in ex-post studies and there is a
lack of knowledge on how platforms should be designed and implemented. In
this paper, we elicit functional requirements for the design of a multi-sided
health and wellbeing platform based on interviews with both end-users and
stakeholders. These requirements provide the basis for future design cycles in
which, the development and actual implementation of a platform is foreseen.

Keywords: Design science
Service platform
Health and wellbeing
Smart

living
Matchmaking
Stakeholders
Social infrastructure

1 Introduction

Smart living services [1], aimed at people living at home, are not yet widely adopted
[2–4]. Services can be seen as the non‐material equivalent of a good, which is intan-
gible by nature and is offered by a provider to its consumers as a value [5].
Two decades ago, Mark Weiser envisioned a world where numerous of intercon-
nected intelligent devices and networks serve human in an unobtrusive way [6].
Despite the technological advancements in recent years [7] such vision still has to
become reality in daily life [8] and can be explained by (1) the tools are missing for
stakeholders to create awareness among end-users about existing solutions and (2) the
highly fragmented market hinders end-users to find products and services that they
need, and (3) the predominantly technological focus of service providers makes it
difficult to understand how services fit end-user needs. Accordingly, a possible
approach to solve issues like awareness, fragmentation and promotion, is to create a
service platform (i.e., a social infrastructure) that connects providers and users of smart
living products and services.
Our research is related to the European Ambient Assisted Living project
Care@Home, that focuses on delivering connected ICT-based assistive living solutions
© Springer International Publishing Switzerland 2015
C. Bodine et al. (Eds.): ICOST 2014, LNCS 8456, pp. 3–12, 2015.
DOI: 10.1007/978-3-319-14424-5_1
4 W.J.W. Keijzer-Broers et al.

involving multiple devices for elderly and enabling them to live an independent life as
long as possible [9].
In this paper, we present the results of the first design cycle for the conceptual
design of the platform, based on two series of exploratory interviews with potential
end-users and relevant stakeholders in the Netherlands.
The paper is structured as follows: Sect. 2 provides a background on the health and
wellbeing domain. In Sect. 3 we provide an overview of the platform literature. In
Sect. 4, the method is described, followed by the results in Sect. 5. Then, in Sect. 6 the
findings are discussed. Finally, in the last section the challenges and an outline of the
next steps are provided.

2 Health and Wellbeing Domain

One of the main demanding markets in health and wellbeing is that of the elderly. The
UN Population Division [10] foresees an increase of the global population over the age
of 60 from 841 million in 2013 (11,7 % of the world population) to more than 2 billion
in 2050 (21,2 % of the world population). Ageing population generates an increasing
demand of healthcare resources due to the associated increase of chronic conditions.
The World Health Organization, but also the European Commission and national
governments promote the concept of ‘active ageing’ and define it as the process of
optimizing opportunities for health, participation and security in order to enhance
quality of life as people age [11]. There is largely consensus that innovative ICT
solutions are required to both reduce costs and help people to stay at home as long as
possible [12].
Although, technologies for smart living products and services are developing
rapidly [13, 14], adoption of these technologies is not widespread. Generally, end-users
are not aware of what smart living services are available and how these services could
fulfil their needs. In addition, the highly fragmented market provides many services,
but no integrated systems, which makes it difficult for end-users to find products and
services. Moreover, especially in the health and wellbeing domain of smart living, end-
users (i.e., elderly and disabled people) typically pass different stages of impairment,
and they are often unaware as to what services they could use at what point in time. The
predominantly technological focus of service providers makes it difficult for them to
understand how services fit end-user needs. Especially technology-focused providers
lack channels to reach users. Finally, besides end-users, there are other stakeholder
groups, which need to be aware of health and wellbeing services (i.e., service and care
providers, manufacturers, facilitators and government agencies).
In this paper, we focus on health and wellbeing services provided on the level of
municipalities. The rationale behind this is that care services in the Netherlands, in
which the study is conducted, are increasingly shifted to the municipal level. According
to plans of the Dutch government, from 2015 onwards, the responsibility and the
execution of healthcare will be even more shifted towards municipalities. Domestic
help is being handed over to municipalities that will be free to decide for themselves
how they will execute tasks and are accountable at a local level for their performance.
A next step is ‘age at place’ either at home or in local communities rather than in care
 Designing a Multi-sided Health and Wellbeing Platform 5

homes and other institutions. Although people prefer to stay at home as long as pos-
sible and deinstitutionalization is also based on the assumption that homecare services
are less costly than institutional services, it also represents a major challenge, as
increased support for homecare has to be provided somehow [15]. This transition will
cause a paradigm shift in the Netherlands, because of the tension between keeping
healthcare a universal good while harnessing costs [16]. Next to that it will have a huge
effect on society and the social inclusiveness of elderly in particular. For that reason
municipalities are searching for technical and organizational solutions to support them
in the transition phase. For example, a service platform with monitoring features, that
support the social intervention of citizens in the context of health and wellbeing, might
be a helpful instrument.

3 Kernel Theory: Platform Theory

As this paper focuses on municipalities, service providers and end-user issues in

establishing and governing a platform for health and wellbeing, we base the theoretical
framework on concepts of platform theory from a multi-sided market perspective (i.e.,
different ‘independent’ providers provide complementary products and services on the
platform [17]). Platform theory is relevant because it provides insights in (1) how
service platforms come to exist and develop, (2) how to identify potential and patterns
for collaboration and (3) how to organize users and form a foundation for their
interactions. Platform theory enables us to clarify what has to be done when designing a
service platform and how to involve different stakeholder groups in an early stage.
Most of the theoretical and empirical research on multi-sided platforms has focused on
mature platforms [18, 19] and less attention has been given to issues in starting up a
new platform [20]. These issues include strategies for attracting different user groups of
a platform and attaining a critical mass. From an economic point of view such a
platform creates a multi-sided market and generally faces a critical mass constraint that
must be satisfied if the business wants to be viable [18]. Therefore, the challenge is to
find out if a health and wellbeing platform is a viable solution and generates value from
bringing end-users and members of different stakeholder groups together. Platforms
typically consist of features such as search functionality, payment administration,
authentication, security, data-access and identity management. Previous studies show
that the proliferation of platforms depends on several criteria such as satisfying multiple
sides of the market [21], governing relationships with third party service providers [22]
and maintaining a degree of openness in order to allow generativity [23]. Since trust in
a platform and building up reputation are also important success factors, the process in
which a platform is designed and stakeholders are involved is far from trivial. In
summary, existing knowledge on platforms is merely based on ex post studies of
successful cases and there is a lack of knowledge on the design of emerging platforms
in the smart living domain [24]. In addition, the issues of how to involve and deal with
external stakeholders during the design process is rarely discussed in literature on new
service design [e.g., 25], service engineering [e.g., 26] or design science research [e.g.,
27, 28]. In our design, we consider the five stages of the typical design cycle from
Kuechler and Vaishnavi [29] (See Fig. 1).
6 W.J.W. Keijzer-Broers et al.

Fig. 1. Extended version design cycle Kuechler and Vaishnavi [29].

Comprising the stages of problem awareness, suggested solution, develop the

artefact, implementation and evaluation as an overview of the patterns (i.e., generalized
system design elements) of the platform design. Although in the design cycle of
Kuechler and Vaishnavi, just one moment is included to measure the performance of
the design, we entered the used methods and added validation steps (i.e., performance
measures) for every phase (i.e., design step) in the design cycle.

4 Method
4.1 Design Science Research
This paper is positioned within the design science research paradigm [30, 31]; a fun-
damentally problem solving paradigm that has its roots in engineering and the sciences
of the artificial world [32]. Design science research attempts to solve a specific problem
and to generate and empirically test a design theory that can be reused in solving a class
of related problems. We adopt a specific design science research method called Action
Design Research (ADR) after a term first coined by Livari [31]. ADR provides explicit
guidance for combining building, intervention, and evaluation in a concerted research
effort. ADR contains two basic activities: building an artifact for a specific purpose and
evaluation on performance of that artifact. We adopt Action Design Research because it
has a dual mission: (1) to make theoretical contributions and (2) to assist solving
current and anticipated problems of practitioners [33]. We use this approach in con-
ducting our research as it provides a scientific research framework for designing a
service platform, but taking into account that designing the platform is an iterative and
sometimes ‘messy’ process.

4.2 Interview Method

In an earlier paper [34], we explored the problem awareness (i.e., first design step) for
health and wellbeing. Through 11 exploratory interviews with different stakeholders,
 Designing a Multi-sided Health and Wellbeing Platform 7

we found that end-users lack awareness of what smart living solutions are available and
how they could fulfill their needs. At the same time, we found that service providers
find it difficult to reach end-users and to market and promote their products and
services. According to the interviewees a platform should solve this mismatch between
demand and supply. In this paper, we analyze 59 semi-structured interviews with
potential user groups and various stakeholders, to develop a solution (i.e., second
design step) for the problem elicited and to address the mismatch between demand and
supply. The results were used for analyzing and testing the first design step. Intervie-
wees were selected in three stakeholder groups that each represents a different side of
the platform: Two external stakeholder groups, like 23 strategic level stakeholders (i.e.,
knowledge institutes, government and funding partners), 17 affiliate level stakeholders
(i.e., service and technology providers) and 19 end-users (i.e., care providers and
citizens) on the other side. First, the aim of the interview was explained: the practical
problem on the mismatch between demand and supply in health and wellbeing and the
suggested solutions. Next, three questions were posed to every interviewee, followed
by follow-up questions and discussion: (1) What should be the main purpose of a
health and wellbeing platform? (2) Who would benefit from such a platform? (3) What
are critical design issues when developing such a platform? Interview reports were
summarized and coded into categories.

5 Results

5.1 Main Purpose of the Platform

To the question: What should be the main purpose of the platform, four main answers
were given. (See Fig. 2).

Fig. 2. Main purpose of the platform according to interviewees.

Most often mentioned functions are information exchange between providers and
end-users. This was especially mentioned by the strategic and affiliate stakeholders, but
strikingly not by end-users themselves. Besides exchanging information about services
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