Modeling health care logistics in a virtual world

Inefficient health care delivery – not patient care but business and support operations, including logistics and supply-chain networks, database- and inventory-management systems and patient-information systems – contributes significantly to rising costs and compromised quality of care and patient safety. To address this problem, University of Arkansas researchers are using Second Life, the popular three-dimensional virtual world in which people work and play online, as a platform for modeling efficient health care delivery.

“As most people know – usually by personal experience – modern US health care is hugely expensive and does not always assure safety,” said Craig Thompson, professor of computer science and computer engineering. “What we’re doing is exploring virtual worlds and ubiquitous computing – that is, the not-so-utopian and imminent world in which everything, including objects, is alive by virtue of being connected to a network – as a model for efficient operations. The ultimate goal is to move beyond modeling, so that these systems may actually be used as tools in real hospitals, real pharmacies and clinics and other care facilities.”

The project is connected to the College of Engineering’s Center for Innovation in Healthcare Logistics and the RFID Research Center, a subunit of the Information Technology Research Institute in the Sam M. Walton College of Business. The former, which opened in 2007, includes an interdisciplinary team of researchers who investigate supply-chain networks and information and logistics systems within the broad spectrum of US health care. Since 2005, the RFID Research Center has conducted studies on the use of radio-frequency identification in retail.

Thus far, researchers – primarily students between the ages of 14 and 50 – under Thompson’s direction have created a virtual hospital with operating suites, patient rooms, laboratories, a pharmacy, waiting rooms, stock rooms and bathrooms. The building, which exists on the Second Life’s University of Arkansas “island,” also includes furnishings such as working toilets, sinks, showers, chairs, beds and various diagnostic and medical equipment such as electrocardiogram machines, respiratory rate monitors, portable X-ray machines, IV poles, ultrasound equipment, computers and carts for transporting supplies. Avatars – virtual representations of people, who, in this case, are doctors, nurses, various staff members and patients – populate the site. When they discovered that avatars are hollow, the students even constructed internal organs to prepare for future functions, including surgical operations.

But these features and objects are merely ingredients, the foundation for a future program that will not only mirror and model current real-world processes but establish superior methods for delivery of important operations, including managing and transporting inventory at all stages of the supply chain. The initial efforts have focused on physical assets and inventory. To this end, researchers have created trucks and other logistics tools – such as forklifts, pallets and even “smart shelves” – to simulate various workflow scenarios call vignettes. The shelves and other equipment, including forklifts and pallets, are smart because they are equipped with virtual RFID tags, which are similar to barcodes but can identify individual items. The system tracks the location of things and who owns or is responsible for them.

But how will people, virtual or real, and the objects mentioned above work together to make a more efficient system? Consider this typical supply-chain and logistics operation as a vignette: An avatar enters a warehouse to fill a supply order. Inside the warehouse, the avatar loads containers of supplies or equipment onto pallets, which are then loaded into a truck. The avatar drives the truck to the hospital loading dock and unloads the pallet. A re-supply robot takes the pallet to various supply rooms around the hospital and uses RFID to access a database that knows the type and quantity of items on the pallet and where to deliver the supplies. Because every item – truck and warehouse entry, pallets, containers, individual supplies and pieces of equipment – in this vignette is either RFID-tagged or otherwise connected to a computer network, a management system can monitor inventory and distribution in real time without any human manipulation. Everything works automatically, because everything is “alive” and constantly communicating with an inventory management system.

“In the ‘everything is alive’ vision, objects talk to each other,” Thompson said. “Our virtual objects do this, and, increasingly, so can wirelessly connected real-world objects. So it’s time to generate a rich collection of vignettes, or workflows, that exercise this capability to understand it better. For example, we’ll work on a situation in which a blood-pressure machine interacts intelligently with an IV drip so that the latter can adjust appropriately based on information received from the former. All of this can happen without fallible humans manually controlling both machines.”

In the everything-is-alive world, people can communicate with and give tasks to objects. The research team will explore how to do this by creating domain-limited, device-specific languages tied to smart devices and database management systems. This will help the researchers develop more sophisticated ways to use devices and avatars, which will lead to higher-level vignettes.

This semester the team will experiment with real-world terrain maps and will import architectural blueprints and computer-aided-design drawings. This will allow the researchers to scale the virtual-world architecture to cover a larger space, possibly the same as a real hospital or college campus. The team will also attempt to bridge the gulf between geographic information systems that excel at map displays and role-playing games such as Worlds of Warcraft.

“Some argue that my students and I are just having fun, that we could model all of these things in older technologies, such as queuing theory,” Thompson said. “My response is yes, we are having fun, and we’re beginning to see how virtual worlds excel in providing users with understandable simulations of business practices. If the real world is moving toward identity-management technologies like RFID to keep track of things, we can get there first in a virtual world, analyze business situations, and then optimize to make them safer and less expensive.”