By Robert PICARD
Engineer from the Corps des Mines, advisor on health at the Conseil Général de l’Économie (CGE)
By Cédric ROUTIER
Head of the multidisciplinary research unit HADéPaS (Handicap, Autonomy and Development of Social Participation), Catholic University of Lille
Agnès D’ARRIPE
Research professor, HADéPaS
and Stéphane SOYEZ
In charge of the workshop on the new neighborhood, Humanicité, at the Catholic University of Lille
Out of a brief attempt to define a “living lab”, the idea is advanced that this procedure is mainly intended for collectively constructing values and bringing diverse stakeholders into relation. Humanicité, a living lab in a new neighborhood in the Lille Metropolitan Area, France, serves as the grounds for a critique and observations that apparently hold for all other arrangements of like sort. Special attention is paid to designing a living lab as an enabling environment and inclusive space. Under these conditions, each stakeholder’s participation can be increased (at least for those who are the least accustomed to the living lab experience) both in innovation and in the activities related to the lab’s territorial dimension.
By Agnès CAILLETTE-BEAUDOIN
Calydial
and Arnault THOURET
Tmm Software
Providing patient care through standardized, prescribed channels allows for a medicine of quality that acts back upon both itself and the doctor-patient relationship. New needs are voiced; and digital technology is here to propose answers, which must be more efficient. Besides this objective, there is the determination to design arrangements and procedures that are both complete and less expensive. The doctor can now imagine and organize supplements to these new forms of care for chronic illnesses by providing an educational content for treatments, assessing medically and economically these new solutions, and diffusing them. The focus herein is on care for chronic illnesses, in particular, renal failure. Medical innovations for remote monitoring at the patient’s home enable the concerned to handle their illness condition while more attention is devoted to their quality of life.
By Caroline GUILLOT
Head of Diabète LAB at the French Federation of Diabetics
Ideas about patients are undergoing a major change in the realm of medicine: a shift from the “patient alibi” to the “patient-actor”. A discourse has shaped this dominant view of patients and put it into words. But how to make this new conception enter the realm of acts and the concrete organization of medicine? Two principal forces are capable of making this change. On the one hand, patients are much more often solicited (for technical reasons), and the doctor’s monopoly over knowledge is being questioned. On the other hand, patient organizations are using this trend to switch from a defensive to a proactive attitude. By analyzing patients’ data, inquiring into their experiences, and trying to co-assess and co-design new solutions for health, these organizations place the patient as an actor in the process of care. It is of utmost importance to closely follow these apparently irreversible trends, since they will transform the realm of medicine.
By Sylvie ARNAVIELHE
Kyomed
and Virginie DELAY
Stiplastics
Noncompliance by patients with prescribed treatments is a public health issue. One of the major reasons for the lack or absence of compliance is often an inadequate interpretation of the therapeutic protocol, which might be complicated, especially for patients taking several medications over a long period. A response to this problem is the connected pillbox. Designed under a program funded by the FUI (Fonds Unique Interministeriel) and tested as a prototype in a living lab, such a pillbox was submitted to an economic assessment and an evaluation of how patients accepted and used it. This study was essential for a product of this sort to be taken under consideration and for defining a marketing strategy. The current program, which should lead to the device being placed on the market in 2019, has signaled the start of new projects for connected devices to better control patient compliance with the oral administration of medication in oncology and to settle issues related to the safety of this sort of ambulatory treatment.
By Véronique LESPINET-NAJIB
Research professor in cognetics
Amélie ROCHE
Postdoctoral student in cognetics
and Quentin CHIBAUDEL
Doctoral student in cognetics
All three from the École Nationale Supérieure de Cognitique, École d’Ingénieurs de l’Institut Polytechnique de Bordeaux (INP Group)
A first (classical) approach to health and disability is user-centered; it has come out of the ergonomics of human/system interfaces. A second approach corresponds to a universal conception (for everyone) borrowed from the field of architecture. The limits and advantages of both approaches are discussed. The two are not contradictory. On the contrary, they may be connected and become complementary. Avenues of innovation in the methodology of design and development are proposed…
By Barbara BAY and Christelle CARRIER
La Fabrique de l’hospitalité
La Fabrique de l’Hospitalité, a laboratory of innovation at the teaching hospitals in Strasbourg, France, is intended to stimulate “co-creation” by hospital employees and users for the purpose of improving patient care and relations with the persons close to the patient. To “make hospitality” by improving the ways human relations and the hospital premises are experienced, resources from the social and human sciences and from design, in particular, are tapped…
By Myriam LEWKOWICZ
Troyes University of Technology, ICD, CNRS UMR 6281 Tech-CICO
How is technology for health and autonomy appropriated, in particular when installed at the patient’s home? According to the theoretical approach to home use presented herein, users must domesticate technology; and this entails eventual modifications and an integration of it in everyday routines. This domestication reaches beyond the adoption or use of a technological device, whence the need to understand what the technology means to users and how it fits into their lives. This theoretical approach lets us see domestication as a process with four phases: appropriation, when the technological device is acquired by its future user; objectification, when it finds its place in the home environment; incorporation, when it is put to use; and conversion, when the user is capable of telling about it.
By Sophie MARTIN
Associate professor and certified dissertation supervisor in psychology at the Paul Valéry University in Montpellier and clinical psychologist specialized in neuropsychology at UEROS
Denis BROUILLET
Professor of cognitive and experimental psychology at Paul Valéry University in Montpellier and member of DynaCSE, a team in Epsylon Laboratory
and Gérard DRAY
Research professor at École des Mines in Alès – Institut Mines-Télécom
According to the paradigm of embodied, situated cognition, the body, environment and situation are interlinked with cognition. What we know is not abstract but fundamentally related to our sensorial and motor systems. Observing and comparing the interrelations between subject, environment and situation, living labs bring to light the preferred means of adaptation. They explore the choices made by individuals and, too, the reasons why they do not make a choice. Their findings are, therefore, coherent with the operation of human thought processes, which are embodied and situated, and with conceptions of health and disability conditions. Living labs, a source of induction and abduction in a natural environment, provide for the controls necessary to build up scientific knowledge. They are genuine tools that reach beyond innovation. The changes thus proposed are based on a strategy of “e-novation”, management and appropriation by and for the concerned.
By Olivier AROMATARIO
Engineer, INCa/IReSP/EHESP, doctoral student in public health at UMR 6051, CRAPE/ARENES EHESP – Université Sorbonne Paris Cité
Connected devices and health applications are ever more present in everyday life. What is the real value of these tools for health? We must examine the levers for affecting the population’s state of health and identify the ones effective for prevention work. Behavioral changes are fundamental for preventing illnesses that are avoidable and not transmissible; but electronic devices and applications might, or might not, stimulate such changes depending on how they operate. From the viewpoint of ethics, e-devices risk increasing inequality in health depending on how accessible they are and, too, on how adapted they are to people’s expectations. E-tools will have a major place in the patient’s life, depending on the psychological, social and environmental conditions. What theory can be worked out about these health devices and applications? This question is worth examining since it helps us orient the types of action to be undertaken in order to develop e-devices with the population and for the purpose of responding to its needs.
By Jean-Marie MOUREAUX
Professor at the Lorraine University and researcher at the Centre de Recherche en Automatique de Nancy (CRAN)
In recent years, digital technology has grown considerably in the field of health. Medical images and videos are now being massively produced. These key data for providing care require procedures for their transmission, storage in archives and use for other purposes. Since algorithmic procedures might damage images to varying degrees, measuring the quality of images is a major scientific and economic issue, given the sensitive nature of these data and their uses in health. The concepts of subjective and objective quality are discussed; and devices related to them, described.
By Guillaume JÉGOU
Head of the Laboratoire Usages et Acceptabilité, Institut de Recherche Technologique B-Com
and Nico PALLAMIN
Institut de Recherche Technologique B-Com
The maturity of digital technology and the new generation of devices now available for producing virtual reality allow us to imagine applications that would have been hard to realize a few years ago. For professional uses, virtual reality is now serving purposes in education, simulation and tele-collaboration. For the design of products and services, in particular of innovations with little feedback from experience, virtual reality can potentially shorten the design-assessment cycle and the time needed for feedback on the means of interaction or visualization. Nonetheless, much research is still to be done about hot to optimally use all these possibilities. Certain current issues must be addressed. How to improve credibility and enhance the virtual presence? What new tools exist for non-intrusive observation; and how acceptable are they?
By Mathias BÉJEAN
Associate professor at Université Paris-Est-Créteil-Val-de-Marne
and Jean-Claude MOISDON
Professor and honorary director of research at Mines ParisTech – Institut Mines-Télécom
Thanks to their agility and openness, living labs hold promise. They seem to be an appropriate response to the challenge of contemporary innovation, especially in health. Nonetheless, their procedures, in particular the relation to sponsors, are not transparent enough. More effort should be put into formalizing them, all the more so since many living labs, beyond the initial phase of co-engineering, seek to become durable, economically viable structures and to be a driving force for proposing innovative solutions. In this task of formalization, the procedures of living labs can be related to those, already formalized, of research-intervention. Both these approaches are descended from “immersive research”, from which we can learn…
By Yves CHARPAK
Public health doctor and epidemiologist, formerly principal advisor at the regional bureau of WHO for Europe in Copenhagen, vice-president of the Société Française de Santé Publique
Citizen participation in decision-making has two distinct aspects in the field of health. First of all, how to implicate citizens in whatever has a direct bearing on health problems, their own or those of persons close to them? The second, more general, aspect has to do with involving citizens in decisions about the health-care system and its organization. The following topics come under discussion: citizen participation in decisions about funding the health system; their responsibility for this system’s lack of efficiency (owing to their poor use of health services); the systemic causes of the system’s inadequate organization; and the role of the “producers” of health risks before the start of illness. Thought is devoted to introducing the concept of “health literacy”, or rather of forms of literacy related to each of the aforementioned topics.
By Gérard DUBEY
Professor of sociology at Télécom École de Management – Institut Mines-Télécom
On the margin, and in extension, of the processes of abstraction and control, digital technology in the field of health translates into technical language the strong desire (which, in essence, is not technical) for emancipation and reconnection with the world. How to relearn to touch, to feel, to renew a sensorial relation with the material and social worlds? These trends, which we observe in society, clash with other fascinations: “automaticity”; putting health into digits following rules for making calculations; and disembodiment, synonymous with freedom. Far from being obsolete however, the flesh clearly emerges as the horizon for our thoughts even as we resist the magic of digits and the spell of breakthroughs.
By Valentin BERTHOU
Doctoral student at Troyes University of Technology
and Robert PICARD
Engineer from the Corps des Mines, advisor on health at the Conseil Général de l’Économie (CGE)
Living labs in patient health and autonomy are an innovative response to the complexity of health-care institutions. Based on open innovation, they propose an organizational model that combines the participation of a wide range of stakeholders on the supply side with the contribution of users in the effort to design products and services. Living labs have a significant place in the health system as a third party owing to their determination to be innovative. Since the activities of engineering and design is underlaid by an organization similar to that of start-ups, living labs can deploy innovative solutions that find their market and are capable of addressing the issues of chronic illness and demographic ageing.
By Christine CALINAUD
Head of the e-health program at Lab Santé Île-de-France
and le Pr. Jean-François DHAINAUT
Director of Lab Santé Île-de-France
Lab Santé Île-de-France has emerged on the initiative of the Health Agency for the Île-de-France Region, the intent being to create an environment friendly to health innovations. Its founders are the Chamber of Commerce and Industry of Paris Île-de-France and the technology cluster Medicen Paris Region. Its assignment is to stimulate, diffuse and evaluate innovative solutions that, as best possible, match the public health priorities: “ageing well”, long-term care, and tomorrow’s health organizations. Lab Santé Île-de-France presents itself as an accelerator in the service of public and private actors in health and the economy of the Île-de-France Region. Its actions try to open the access to health innovations to everyone; it is associated with an independent committee of ethics. The objectives are to increase opportunities of value-creating cooperation for all parties and to make innovations in health a lever for developing the economy and creating jobs.
By Jean-Yves FAGON
Ministerial delegate on innovations in health
When creating a delegation for innovation in health, Marisol Touraine, France’s minister of Social Affairs and Health, sought to set up a “strong, coherent, transparent and comprehensible policy based on partnerships in matters of innovations in health”. A global, coherent policy: global because it applies to the whole range of health innovations while adapting to specific conditions in certain fields; and coherent, because it is based on coordinated contributions from all parties. This declaration of a clear national strategy does not prescribe a locked-down system. This strategy calls for a strong governance to set the direction for all parties and guarantee continuity in implementing its orientations, while retaining the agility needed for innovation. The solid, strategic chain, thus built, will allow for simple, rapid and fluid exchanges among all parties. Not only are administrations, public operators and industrialists concerned but also health professionals and patients/users – the latter now being full-fledged actors. It is high time that the experiences of both patients and health-care professionals contribute to the processes of drawing up and assessing strategies.
By Eva KEHAYIA, Sara AHMED, Philippe ARCHAMBAULT, Joyce FUNG and Anouk LAMONTAGNE
Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Montréal (Canada) and the School of Physical and Occupational Therapy, McGill University, Montréal
Bonnie SWAINE and Dahlia KAIRY
Both from CRIR and the École de Réadaptation, Faculty of Medicine, Université de Montréal
Guylaine LE DORZE
CRIR and École d’Orthophonie et d’Audiologie, Faculty of Medicine, Université de Montréal
Hélène LEFEBVRE
CRIR and Faculty of Nursing Sciences, Université de Montréal
Tiiu POLDMA
CRIR and Faculté de l’Aménagement, Université de Montréal
and Delphine LABBÉ
Occupational Science and Therapy, University of British Columbia
Conducted by CRIR, a multidisciplinary research center on rehabilitation, and its partners, the living lab RehabMaLL has helped create an environment that, in a shopping center in downtown Montreal, facilitates the participation and inclusion of people of all ages, in particular the physically disabled. Besides its principal partner (FPI COMINAR who owns the shopping center), this program involves communities, associations, clinics and private operators along with researchers as well as local, national and international businesses. This living lab has emerged out of the active commitment from (and synergy between) researchers and stakeholders who intend to lift the obstacles created by discriminatory physical and social environments. This change has been realized through innovative solutions and strategies for reducing inequality and promoting accessibility, well-being and, as a consequence, the health of the people of Quebec.
By Philippe J. BERNARD
Economist, chairman of Club Utopies (Association Prospective 2100)
and Alexandre ROJEY
Founder of the think tank IDées (Tuck Foundation) and vice-president of the association SENS+
Invented in 1516 by Thomas More in response to The Praise of Folly written by his friend, Erasmus, the word “utopia” refers to an ideal place that exists nowhere. Nowadays, it has various meanings. For some, a truth stated prematurely. For others, a naive or dangerous vision: in particular the fantastic promises made by technical progress, especially in digital technology. However the focus herein is not on the prevention of all illnesses; nor on making the life span longer; nor on the enhancement of human thought processes thanks to all sorts of devices to be grafted onto the brain (whence transhumanism); nor on predictions for 2040. Instead, a critique of what actually exists leads us to the question of a vision – maybe a dream or, in any case, a project – for a better society both in terms of its political and social organization and its cultural traits.
