See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/228688210 Building an Agent Based Community Care Demonstrator on a Worldwide Agent Platform Article · August 2003 DOI: 10.1007/978-3-0348-7976-7_3 CITATIONS READS 4 25 3 authors: Martin D. Beer Richard Hill 90 PUBLICATIONS 606 CITATIONS 115 PUBLICATIONS 322 CITATIONS Sheffield Hallam University SEE PROFILE University of Derby SEE PROFILE Andrew Sixsmith Simon Fraser University 134 PUBLICATIONS 1,646 CITATIONS SEE PROFILE Some of the authors of this publication are also working on these related projects: Multi Agent Systems for Educational Uses View project All content following this page was uploaded by Andrew Sixsmith on 13 January 2017. The user has requested enhancement of the downloaded file. All in-text references underlined in blue are added to the original document and are linked to publications on ResearchGate, letting you access and read them immediately. Building an Agent Based Community Care Demonstrator on a Worldwide Agent Platform Martin D. Beer Richard Hill Andrew Sixsmith School of Computing & Management Sciences Sheffield Hallam University Sheffield, United Kingdom School of Computing & Management Sciences Sheffield Hallam University Sheffield, United Kingdom Department of Primary Care University of Liverpool Liverpool, United Kingdom m.beer@shu.ac.uk r.hill@shu.ac.uk ABSTRACT This paper describes a project designed to show how a global multi-agent architecture can be used effectively to support care in the community. Services in this area are notoriously difficult to coordinate with the direct and indirect involvement of a large number of independent, autonomous agencies, each of which has its own priorities and aspirations. Also, by the very nature of the services provided the caring community is highly mobile and distributed making the collection and dissemination of information extremely difficult. The Integrated Community Care (INCA) project has been designed to show how multi-agent technology can be used effectively to address some of these issues in a timely and cost-effective manner. The flexibility provided by such an architecture allows an integration of services based on a regularly updated Individual Care Plan in a way that has been very difficult to achieve in practice. This increased flexibility not only allows the better customisation of the care to the current needs of the client but also provides an effective means of recovery when things go wrong. 1. INTRODUCTION The need to support the elderly and disabled population in the community is widely recognised, however managing the care provision and health of such a group by established means is highly resource intensive. For example, about 13% of the European population are currently aged over 65, with about 7% aged over 75 years. In the UK, there will be 1.2m people aged 85+ by the year 2000, an increase of 30% over a ten year period. Expectations for the EU-wide population are that around 30% of people will be aged over 65 by 2025. This growth, and the physical distribution of the population, severely limits the future effectiveness of conventional health and ability assessment methods. Recent years have seen a shift in focus in the services provided to older and chronically sick people from institutional sixsmith@liv.ac.uk care to care in the community. Community Care is typically provided by a range of independent organisations and agencies, each needing to meet its own targets and objectives and to integrate the service with their other responsibilities in a coherent and efficient manner. This often leads to serious service inefficiencies, as there are inadequate systems in place to share relevant information without compromising the security of the information held. Another factor is that a considerable amount of community support is provided by informal carers who are excluded from the general care management system because of difficulties in integrating them without breaching the official confidentiality requirements. The growth of an effective open agent network such as AgentCities [20] allows effective co-operation (information sharing and communication between autonomous information systems) to take place without compromising the security of the client and the agencies involved. Since each agent has complete autonomy it can respond according to the rules of the organisation it represents, providing an effective and assured guardian that is totally under that organisation’s control. In this paper we describe the principles behind a distributed multi-agent-based Integrated Community Care (INCA) system. A demonstrator system, implemented using the ZEUS agent-building toolkit [16] is also described in order to demonstrate the feasibility of the approach and its potential practical benefits. This demonstrator shows that the technologies proposed allow effective communication without compromising integrity and privacy. In particular they allow an approach to be taken that allows minimum collection of information in that the Home service agent can be configured so that it only releases private or sensitive data in case of an emergency, when such information is of value. The objective of the INCA Project is to investigate how community care can be developed in the internet age through the use of multi-agent technology. The motivation for this has been a consideration of the agent society’s social abilities in: • Promoting effective care systems that: Permission to make digital or hard copies of all or part of this work for personal or classroom use is granted without fee provided that copies are not made or distributed for profit or commercial advantage and that copies bear this notice and the full citation on the first page. To copy otherwise, to republish, to post on servers or to redistribute to lists, requires prior specific permission and/or a fee. Copyright 2001 ACM X-XXXXX-XX-X/XX/XX ...$5.00. – provide better services and resources to clients, – enhance social interaction between them, and with their carers – deliver more effective care • Providing the high-abstraction level care management strategies by linking all relevant agencies into a single framework of accountability. • Giving an in-depth understanding of the health information framework that underpins the delivery of high quality, effective community care, including the formularisation of the links between the disparate agencies involved. • Establishing a single agent-based care monitoring facility that can be used by all care professionals to assist in effective monitoring and diagnosis. • Developing cooperative structures within the community structures to change service provision and care policies through the use of automated agents involvement in planning, scheduling, organising (both formal and informal) care and even directing care service programs. • Devolving care management and responsibility to those providing the care by providing shared supervision and teamwork and by separating the organisational from the social requirements, developing a much more responsive and client centred environment that adapts rapidly to changing needs. Some of these objectives have already been investigated in the medical domain through the use of multi-agent system architectures. For example, the GUARDIAN system [10] considered patient monitoring in a Surgical Intensive Care Unit. Support is provided for collaboration among specialists, each an expert in a specific domain but fully committed to sharing information and knowledge among each other and the nurses that continuously monitor the patient in the physicians’ care. A system devoted to diabetes care has been presented, where cooperation not only between the medical specialists, but also others, such as administrators is supported within the agent community [13]. An agent-based system has also been described that supports collaboration among general practitioners and specialists about patient healthcare [11]. A more general agent-based telemedicine framework has been reported [5] that can assist specialists in diagnosing difficult cases through information sharing, cooperation and negotiation. In this case each specialist has their own Telemedicine-Oriented Medical ASsistant (TOMAS) agent that behaves as a medical assistant and has two generic functions: • an agenda for managing appointments, and • methods for access to patient records. Support for tele-medicine is given by software features for remote exchange of patient data, cooperative annotation of cases and negotiation of appointments. These approaches have been greatly assisted by moves to standardise medical information through attempts to formalise patient and other records [6]. Some of the flexibility offered by the mobile access to records and services is being demonstrated by the Ward-in-Hand project[1], but only in the relatively restricted environment of a conventional hospital ward. The INCA project aims to take these forward from the purely medical domain and integrate them into the general community care environment, where the linkages are less formal and effective cooperation and negotiation is essential if appropriate care is to be delivered. A major difference is that it is rarely possible to share information as freely as within the purely medical domain because of the involvement of different agencies and individuals with widely differing requirements. The agent community therefore has to act as a coordinator and filter to ensure that appropriate and correct information is distributed to all concerned. Also, since help is likely to have to travel some distance it is often better to provide whatever assistance is readily available in a timely manner, rather than the optimal solution that may arrive too late. 2. OBJECTIVES OF THE DEMONSTRATOR This paper describes a demonstrator that uses multi-agent technology within such an open networked agent environment as a means of enhancing the mechanisms for the systematic and widespread assessments of the health of the elderly out-side of a conventional clinical care regime. Enhanced assessment will provide valuable and timely source of information and knowledge that will enable the optimisation of care provision and management. Non-invasive assessment technology can also provide a source of health information that is well suited to identifying subtle, yet important, changes in an individual’s condition. When this is combined with appropriate knowledge sources available elsewhere on the agent network it can trigger pre-emptive care and treatment. [9] Appropriate care can then be provided in a timely manner so that it can be most effective. Agents can also communicate across the network to proactively provide information of interest to combat social isolation and exclusion. The specific approach taken towards this problem is to develop and evaluate technologies suitable for relating behaviour in the home to information and knowledge sources that health management professionals require. The demonstrator explores the following three functional elements: Within-home monitoring techniques The objective is to develop devices that can be readily integrated into existing home environments. Such technology may be passive such as movement monitors, etc. However, we shall also focus on explicitly designed assistive technologies for communication, mobility and environmental control, which are also important. The value of using assistive technologies, as a means of monitoring behaviour is that the data generated is semantically richer and better suited to comparison between individuals. [8] Automated Log Analysis Usage data can be retrieved via an established communication mechanism, and automated analysis techniques will be developed to provide preliminary information on end-users activities. The key requirement of the analysis is to provide data abstractions that are relevant and meaningful to care professionals, both in terms of an individual’s behaviour and in terms of in community status as a whole. Agent based knowledge management The AgentCities network can be developed to provide mechanisms for aiding the review care for specific individuals and at the community in general, and directing care management and delivery. MODEL OF CARE Direct Care Activities Indirect Care Activities Organizational Activities Routine Assessbbment Marketing Emergency Planning Personnel Quality of life Quality assurance Financial Figure 2: The Basic Components of the INCA Architecture describes the Individual Care Plan as: ’not simply a ’basket of goods and services’, it is a complex set of human relations, and the achievement and maintenance of which requires skills, both in the negotiation and management of change’ [p61] Management Figure 1: High Level Activity Model of Care 3. THE CARE ENVIRONMENT Current health and social care policy reflects the view that most older frail or disabled people would prefer to live in their own homes rather than in hospital or nursing home settings. ”Community care” refers to the range of services delivered in the person’s own home or community setting, in order to help them to continue to live independently. Typical services include home helps, meals, domestic help and community medical and nursing services. Although the humanitarian perspective is compelling, the delivery of community-based services presents a number of organisational, managerial and logistical problems that undermine the effectiveness and efficiency of services. While community care has typically involved limited use of information technology, recent developments have seen significant application development, a trend that is likely to significantly develop in the future. An information technology within community care currently involves a number of autonomous systems; home monitoring, community alarms, care management systems and emergency systems command and control systems. Each element of care is provided by different autonomous bodies, which maintain their own individual management information systems. The overall management of the care typically resides outside of these systems, protecting individual bodies from disclosing sensitive and irrelevant information. Key to the development of a proper care regime for any client is the Individual Care Plan that provides the link between the client’s needs and the means by which they should be met. This not only includes the Direct Care activities normally associated with community care and discussed elsewhere [3], but also the indirect and organisational activities as showen in Figure 1. These need to be reviewed and updated continuously as the client’s requirements change both by monitoring and analysis of information collected [8] and through negotiation between the agencies, as appropriate. Indeed McDonald [14] Its preparation is therefore a complex process that requires flexibility and support for contingencies so that the necessary services are provided in a timely and efficient manner. Figure 2 gives the basic components of this process. 4. REASONS FOR AN AGENT APPROACH One area that is critically dependent on the ability to negotiate appropriate solutions effectively is Community Care. The move towards franchising of different aspects of care delivery with the responsible agency (in the United Kingdom this is usually the Social Services Department of the Local Authority) being responsible for preparing a detailed specification, in the form of an Individual Care Plan. It then contracts various agencies to actually deliver the various components of the care, as appropriate. There is now no single agency with the overall authority to plan, manage, deliver and monitor the provision of community care, and so no single control authority and network. To this must be added the various health care services, and the emergency services, each of which have their own independent records and command and control structures, but are essential components in the delivery of the overall package. In addition, there are the large numbers of informal carers (family, friends, neighbours etc.) who are currently almost totally ignored by the system, but provide invaluable support. Jennings et al. [12] in reviewing the ADEPT project interpreted organisations as distributed federated structures incorporating competition and coordination and proposed that agent architectures are highhly suitable for mirroring this structure. This is basically the approach taken by INCA but care has to be taken not to take this analogy too far as for example when Symonds and Kelly [19] talk about the ’myth of the market’ since in our case: • the prime consumers (the Clients are not the actual purchasers • occupational regulation overrides market regulation • legal obligation overrides market opportunities • risk to others makes it a social issue rather than an individual matter. All these are prime research issues for the agent community and need to be addressed if widespread deployment of any but the most basic trading agent-based solutions are to come about. In particular, the AgentCities approach can: 5. THE AGENT ENVIRONMENT An agent mediated approach makes it possible to integrate the existing care systems in a way that makes cooperation natural between highly heterogeneous agencies, since only the communication now has to be standardized. It allows • Replace conventional technology, such as existing telephone- the INCA system to interface directly to a wide range of exbased services [7] isting databases, knowledge bases and control systems that are already in place. The much broader care picture can • Integrate specific functions into a single, comprehentherefore be monitored effectively, and is of great help to sive, framework for service delivery. The end users will care managers in developing the most effective and efficient then have a single access point to services, rather than care programme for each individual, including the eliminathe piecemeal approach currently adopted. tion of unnecessary duplication of resources. Ensuring that the most appropriate assistance is provided • Enhance information sharing between all parties in a in reasonable time is a significant focus of the research. The controlled and open manner through the interoperavarious potential agencies have differing capabilities and can tion and cooperation of different sets of agents from respond in various ways, and in differing time frames, each different communities. having its own defined cost. Depending on the nature of the incident to which a response is required a decision as to • Develop new services, particularly those aimed at enthe most appropriate response has to be arranged. This will hancing quality of life. These may well include more require multi-dimensional negotiation at a number of levels general services from other service providers and agent if acceptable levels of service are to be assured. The current communities. arrangements have great difficulty with this as only limited information is available. It may for example be appropriate • Provide flexible, rather than dedicated, solutions, which to notify an informal carer who can respond rapidly because are readily customisable to an individual’s changing they are close to the scene either in place of or in addition requirements. to a professional carer or the emergency services so that at least some assistance is available at the scene. This more The objective is to provide a very much more responsive sophisticated approach can only work effectively with full and effective service. If each has to rely on only its own inforcooperation and information exchange between all parties mation valuable time and resources will inevitably be lost in involved. duplicating actions. Even a minimal level of co-ordination The issue of timely intervention when delivery of the ascan therefore be extremely valuable. It must however be sistance promised fails also needs to be addressed, in that managed effectively to: the appropriate agent must identify the anticipated failure as soon as the problem becomes evident. It must then at• Maintain the autonomy of all agencies tempt to renegotiate its commitment, either by finding another agent that will take it on, or by making a revised • Maintain the privacy of the older person as far as poscommitment. The agent can then develop a record of the sible reliability of the various agencies and build this into its negotiating strategy. The process of negotiation is not as well • Ensure the security and integrity of the information founded in conversation theory as request and response exheld changes, because there are much many more conditions that may apply. In the case of the INCA project these are simpli• Link with others involved (such as informal carers), fied somewhat as it can be expected that all agents will use who do not have their own systems, but are a valuable their best endeavours to meet all commitments that they part of the total care package. enter into. This simplifies the analysis, without losing too much generality. The AgentCities approach adopted in the demonstrator: A major advantage of this approach is that the Home Unit (and sensors attached to it) can provide a range of services, • Effectively separates out actions that require different rather than just one, as in the case of a Home Alarm or simscenarios to be followed ple monitoring unit. Services can be added, modified and removed as required, providing a very high level of flexibility • Provides an effective means of co-ordinating separate so that the changing requirements of the Older Person can autonomous agencies through integration with their be met in the most effective manner. This flexibility also exown systems tends to the various care agents who may be linked through their existing command and control systems or through spe• Allows additional information to be added through the cial mobile agents or both, depending on their position and use of mediators and agent-based negotiation stratecurrent status. This approach follows that outlined by Beer gies, based on the established need, in the form of an et al. [2] Individual Care Plan. • Effectively integrates informal carers into the planning, delivery and monitoring of care, even though they do not themselves have either the use of or access to complex planning and control systems. 6. THE PROBLEM AREA ADDRESSED While community care covers a wide range of activities, four basic scenarios are considered in this paper, chosen to illustrate the effectiveness of the agent-based approach in developing a fully cooperative environment for providing the care required: 1. The development and updating of an Individual Care Plan. Care Planning is the specification of a package of care services according to an assessment of the needs of the individual. 2. The monitoring of the effectiveness of that Individual Care Plan Table 1: The Actors 3. Responding to failure to deliver the specified care in a timely and effective manner 4. Reviewing the Individual Care Plan so that it continues to meet the objectives and desires of the client. NAME Care co-ordinator A number of organisations and individuals play a part in these activities. They can be grouped effectively into groups of actors, as shown in Table 1. The interactions between these actors can then be shown in the form of Use Case diagrams. 6.1 Developing an Individual Care Plan Before care can be provided effectively, the care co-ordinator has to assess need, and develop an individual care plan that meets the older persons requirements. This can be quite difficult, particularly with the severely disabled or those with dementia. If assessment is undertaken at an assessment centre it ignores the specific circumstances and problems that occur in the home environment. However observation of a person in their own home requires considerable resources if an effective result is to be achieved. The monitoring facilities of the INCA system provide an effective means by which this assessment can be made within the client’s familiar environment, which can be further refined as additional information is collected. A significant part of the assessment is determining what the overall objectives of the care regime are to be. These may include enhancing the quality of life by for example maintaining or improving one or more of: Care provider Informal carer • physical health and wellbeing • emotional or mental health • peace of mind • safety and security • practical support • personal care • personal finances • control over day-to-day life • reduction of risk as well as rehabilitation outcomes such as: • regaining skills and capabilities • improving confidence and morale • improving the ability to go out • reducing symptoms Client DESCRIPTION The agency responsible for providing the range of services necessary to ensure that the Older person is properly cared for. The Care co-ordinator is responsible for preparing a Care plan and for monitoring its effectiveness in meeting the needs of the Older person. This is often the Local Authority or some other official body with a legal duty to provide the necessary care. The various agencies and individuals responsible for providing the care specified by the Individual Care Plan. This will include Social Workers, Health Care Professionals, Care Assistants, Emergency Services, Social Services etc. who can provide and extremely wide range of care services, if required. The various relatives, friends, neighbours etc. who provide some form of support and assistance in an informal way (i.e. outside the Individual Care Plan), but is often essential to allow the older person to remain living at home. This is often flexible and responsive and can range from totally unstructured and so not recognised at all in the Individual Care Plan through to fully recognised and integrated with the efforts of the professional carers. The person who lives in their own dwelling (either an ordinary house or a sheltered home) and who receives a package of community care services. This package may range from very minimal interventions, such as social alarm systems, through to an intensive mix of community support services. Invite Tender Care Provider Care Provider Arange Cover Negotiate Informal Carer Make Contact Speciy services required Select Provider Notify assesment Informal Carer Assess needs Inform C|lient Call Centre Care Coordinator Client Figure 3: Individual Care Plan Development Decide if Cover Needed Monitor Intervene IIndividual Care Plan Figure 5: Responding to Failure Update Intervention Log Internal Carer Care Provider Liase Care Coordinator Check Interventions against Schedule Client Figure 4: Monitoring the Individual Care Plan This means that the care regime needs to be developed continuallyt as the balance of these objectives changes. Also, the choice of carer depends not only on their own capabilities but also on the current set of objectives that the Care Coordinator wishes to achieve. This makes the choice of carer not just a simple resource allocation issue, bu one where quite complex negotiations both with the client and the carers may be required. The INCA architecture also allows informal carers to be recognised as an integral part of the care regime and for them to be properly informed at all stages. This is important as many of the objectives outlined above can be best achieved by close friends and family, but this must be recognised within the framework otherwise considerable duplication of resources will ensue. This is a major issue with current care systems, where they are often effectively ignored. The stages in doing this are shown in Figure 3. 6.2 Monitoring the Care Plan Once the care plan has been established it needs to be continuously monitored, and regularly reviewed, otherwise the care regimewill rapidly drift away from meeting the real needs of the client. The INCA architecture provides for this by continuously monitoring both the client and the care interactions, and identifying when further intervention is required. Figure 4 shows the interactions involved in informing all concerned of the care required at any time. 6.3 Responding to Failure In any system dependent on such a wide variety of autonomous individuals, there are inevitably occasions when the necessary levelof care, as specified in the Individual Care Plan can not be delivered at the time specified. This can range from a particular carer being held up in traffic to serious problems that put the safety and wellbeing of the client in jepordy. Contingancy arrangements havre therefore to be included, that are triggered as soon as the potential failure to meet the care obligations is identified. Agent architectures can be shown to perform well in this respect, without developing serious instabilities that would affect large numbers of other individuals. This is important both for maintaining the stability of care to all clients and for scalability reasons. Figure 5 shows the interactions involved. 6.4 Reviewing the Care Plan Finally we need to consider the processes required to review the Individual Care Plan as shown in Figure 6. Considerable volumes of information are being generated continuously about both the client and the operation of the care regime. When the safety and security of the client is assured, much of this information will simply stay in the Home Unit where it will be used to identify longer-term trends. When ann issue arises, not only will an emergancy response be triggered to deal with the immediate problem, but the diustributed agent architecture also provides for the Individual Care Plan to be reviewed. Since different information is required for this purpose than for immediate response to the initial emergancy the data filtering and knowledge synthesis capabilities of an agent-based information system come directly into play [17][18]. 7. USING THE DEMONSTRATOR The current demonstrator deploys home agents across the Agentcities network. They then communicate with the rest of the agents on the main platform. Potential users can download the necessary code to deploy their home agent from the project web site. They then need to install this in their own version of the Zeus agent plqatform [16] and when the full set of local agents are started communication is es- 5. differing configurations to deal with a range of circumstances. For example, the monitoring facilities could be used in burglar alarm mode when the property is unoccupied and carers could be informed as appropriate to avoid wasted journeys. Informal Carer Client Monitoring uses Care Provider Trigger uses Assess Care Coordinator uses Sespecify Package Figure 6: Reviewing the Care Plan tablished with the INCA server and a minimal Individual Care Plan is prepared. This deals solely with the handling of emergancy alerts which are routed directly to the Emergancy Services. The system is thus able to respond to basic requests for help immediately. Once this initial plan is entered in the database the user is able to access it through a web interface that allows it to be modified as required to meet individual need and the home unit agent can be used to assess the effectiveness of the INCA architecture to meet that need. 8. FURTHER WORK There are a number of additional agents that could benificially be deployed to demonstrate the capabilities andf flexibility of the INCA architecture. These might include: The mobile agents are already under development using the JADE/LEAP platform. These will deploy to PC hosted simulators for typical mobile devices in the first instance. Whether we shall be able to allow free deployment in the same way as the home unit agent will depend on the licens restrictions imposed on us by the various software suppliers. Current intention is to allow free deployment of as many different types of agent as possible so that we gain a wide evaluation of the technology from as many potrential users as possible. The current demonstrator is concerned primarily with the delivery of a specified service level. It therefore deals with the communication and negotiation between the various interested parties rather than the detailed operation of the sensor networks in the home. There are other projects that are concerned more directly with this.[4][8] 9. CONCLUSIONS The INCA project can now demonstrate the effective deployment of a set of agents designed to cooperate in the timely and effective delivery of community care across the Agentcities network. The cooperative activities are very different from the trading situations that have been studied extensively, and so this project gives very different insights into the design and construction of large-scale multi-agent networks. In pareticular we can study: • the architectural consequences of using an open multiagent system to support an application domain that requires high levels of reliability and security • the interactions between the various autonomous information sources and the architectural requirements for their reliable interoperation with the various agents. This brings us into the area of Web Services and will allow us to inform the debate on how such services should be built and integrated. 1. mobile agents that emulate wireless connected Personal Digital Assistants (PDAs) that can demonstrate the communication possibilities for the various care workers involved • the use of mobile and static agents to deliver the necessary services and the implications for doing this on a global platform 2. a global monitor that shows the home agents connected and their status at any time. This is likely to be Web based and be linked to the pages that allow modification of the Individual Care Plan. • scalability issues as any realistic scenario for deploying INCA would require the linking of thousands of home units and hundreds of carers. We need to study the behaviour of networks of this size before we can even think of trying to deploy such agents. 3. customised help and information services based on information agents that know of the client’s interests and requirements. This can have a considerable benefit in combatting social isolation. 4. monitoring facilities not only for the home, but also for the carers so that the client knows when to expect them, and is kept fully informed of any necessary changes in plan. The use of a general agent network architecture means that agents can be deployed on existing and future agent architecture without the necessity to construct independent architectureal frameworks as has previously been the case. As more facilities and services become agent based they can be readily integrated into the INCA framework in a way that is just not possible with existing community care frameworks. The current demonstrator intentionally does not use security features that are becoming available on agent platforms, as it is intended as a testbed with which to investigate some of the issues discussed in this paper. The use of a standard agentView architecture and a readily available agent publication stats development platform means that such features as this, and many others can be added very quickly when standards are agreed and they are added to the development environments. 10. ACKNOWLEDGEMENTS The programming of the demonstrator has been undertaken by Iain Anderson, Wei Huang an Philip Doherty as part of the project work required within their degree studies. The project is also in receipt of an Agentcities Deployment Grant from the European Union Agentcities.rtd project (IST-2000-28385). 11. 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