Ask HN: My brother is the director of Alaska VA and asked for help for this app

50 points by samstave ↗ HN
My Brother is Dr. Timothy Dean Ballard - Director of the Veterans Administration for the State of Alaska - Former commander of the 10th Medical Wing for the USAF and previous flight surgeon to the Joint Chiefs of Staff.

He has asked for insight and if an app can be made for the following regarding COVID-19.

---

A smart watch app that can detect, count, and alert on the amount of time one touches their face and a buzzer/reminder for when doing so to minimize the activity.

I pointed out the difficulties in efficacy due to the fact that most wear a watch on their non-dominant hand, sensor false-positives etc...

But he stated, something is better than nothing.

I do not have the skills to create this - and my network in this area is too thin.

Can we please request some help from the HN community to crowd source from you guys to add input to prevent illness....

Please let me know.

https://www.alaska.va.gov/about/leadership.asp

http://www.ww35.usafunithistory.com/PDF/10-19/10%20MEDICAL%2...

32 comments

[ 3.4 ms ] story [ 57.8 ms ] thread
There is a group inside the VA that might be able to help with it.

https://connectedcare.va.gov/

They have teams that are working on mobile app's and they may be open to quickly putting together something to try out. They have done similar things in the past.

Also you can check out the VA developer portal. They right now are now focused on stand alone app's, but they have a community they may be able to reach out to

https://developer.va.gov/

As a veteran myself, I’d much rather any sort of money went into something that isn’t the disease of the day.

Kind of find it hard to believe out of all the things one could do to help veterans in Alaska, this is the one thing he wants to do.

I think the precautionary measures being taken will probably also help reduce flu cases going forward so this isn’t covid-19 only, can apply to other diseases too.
This is obviously not "the one thing he wants to do", it's an offhand idea he mentioned to his brother.
You certainly have insight into the needs of veterans that I don't have, but...

> something that isn’t the disease of the day

I wouldn't look at it this way. First of all, it's going to be around for at least 18 more months. Many thousands of people will die.

Second, veterans will be at higher risk than average Americans for various reasons (age, injuries, etc.)

> Kind of find it hard to believe out of all the things one could do to help veterans in Alaska, this is the one thing he wants to do.

Why do you assume it's the thing he wants to do? Should he ignore Covid-19 entirely because, in your opinion, other issues are more pressing? Can he only work on one issue at a time?

I don't know a lot about the VA, and I do know that it's utterly failed to uphold its promise of taking care of vets, but it's likely that a lot of OP's brother's problems are caused by people higher up the chain than he is. Perhaps he's looking for innovative ways to help that won't be caught up in the failures at the top of the organization.

As someone who often gets asked by government officials on what can be done to improve the lives of X, Y, or Z and what applications can be built and how can we use artificial intelligence in a sector, my first answer is to get X, Y, and Z to the table and in the room then we'll talk.

Alost anything other than that is a hammer looking for a nail, or an app looking for no user.

The same used to happen to us building custom software for enterprise, where an executive starts telling us features to build for analysts/salespeople/marketing/engineering, and what the product should do. We asked access to users and were denied, and got paid for software nobody uses which is demoralizing.

Our position now is: get the analysts/salespeople/marketing/engineering in the room and we'll build a product that drives value just fine.

A lot of problems exist not for lack of a mobile app, and people either fail to see the problems in terms of systems, incentives, friction, trust, etc or there's pressure to show something is being done and an app is a good way to do just that. Activity over output.

My opinion is: although the pressure may be strong on your brother to show something is being done, a good way to actually get things done is to meet the people your brother is trying to serve, and then serve them. Doing that may expose that many of them may have trouble actually acquiring soap, or are disabled and need someone to help them through this, or just need food and shelter.

Sadly, I really agree with all you said - I told him something along similar lines - but I also told him I would field the question, and this being HN, I figured the best place o do so...

He is adamant that we are at the very bottom of the beginning of the curve....... (I am inclined to know that he knows more than he lets on to me (see given creds about him, but I am also paranoid) so I wanted to see what could be done to help his request... he is also infuriatingly calm in any calamity, which is good for a field doc who helped many casualties in Iraq and beyong and in the literal pentagon Joint Chiefs office when the 'plane hit - but frustrating as heck when trying to discern true danger from a conversation with him)

(((I was actually able to get more information from a Loral Space Sat Eng designer neighbor through our "blink if XX is true code about spy sats that I can from my literal brother)))

>He is adamant that we are at the very bottom of the beginning of the curve

I've been pulling 18+ hour days working from home on our product so I haven't paid much attention to this, but looking at the exponential curve gives me the impression that this will change a many things, at least for some time.

One of the things that have crossed my mind is that the financial distress lived by people in easily terminated positions or who do low complexity tasks will lead their children to witness how fragile a livelihood can be. This is more obvious in some societies than others, but the scale at which this will happen true will etch this in memories and many will probably pledge not to go through what their parents went through. Some societies where someone can be out of a job and still live decently because they're someone's brother/sister/cousin/nephew and the safety net makes it hard to starve or freeze. This will cause a mutation.

The realization of what it is to be confined and not free of one's movement. I'm in my thirties but I know what a curfew is from more than a decade of terrorism and civil war. People who are just five years younger than me don't, and people in many countries find it crazy not to be able to go out after 1700 or 1900. This can make people more empathetic with people who need a good reason to go out, or people who simply can't. The disabled and the maimed, the bullied and the threatened, the outcast and the undesirable.

The realization you cannot intimidate or project strength with a virus for it doesn't care if you pull a knife, puff the chest, or command goose-stepping eukaryotes. It doesn't care that someone loves their mother or their child, if someone is a believer, spiritual, an optimist, or a pessimist. It doesn't care about how much someone bench-presses or how many beers one drinks.

This may not be a realization for many people, but a lot of people think that way. That being a badass, a wise-ass, or a dumbass somehow will prevent them from getting infected, and that loving their mom is enough to make things go well. This, too, will change things and will do most likely in painful ways.

This would also stress organizations, governmental or not, and require them to change and come up with ways to survive. For example, the dwindling tax money the revenue service is collecting because of the crisis could provoke an acceleration in electronic payment, and remove some bureaucracy.

Organizations such as ours are forced to learn to work completely remotely, and have message discipline and institutionalize knowledge. We are lucky we've been experimenting with this because we're paranoid enough to have thought that we needed to do it because at some point we'd have no choice but to do it so we're okay, but this could set a precedent in some organizations that eschew remote work with an opinion on productivity.

This may also be a rare occasions for some countries where corruption is high as government officials get tested, government gets changed, and officials simply have no other place to go. What happens in a lot of countries is that the people act as low quality tenants who'll completely ruin a property because they have no ownership and plan to move somewhere else. They can't really do that now, so they have to fix some things or suffer the consequences.

Writing these lines, I'm reminded of a passage in Blaise Pascal's "Pensées":

Man is but a reed, the most feeble thing in nature; but he is a thinking reed. The entire universe need not arm itself to crush him. A vapour, a drop of water suffices to kill him. But, if the universe were to crush him, man would still be more noble than that which killed him, because he knows that he dies and the advantages which the universe has over him; the universe knows nothing of this.

That quote reminds me of where "fascist" comes from...

The individual is week, but a group of reeds, tied together, can be unbreakable....

Interesting. I guess what I was getting at is that I have intimate knowledge with this problem, for the elderly and the same application of what your brother is trying to do.

We wanted to know how they lived, if we could detect and predict anomalies (heart, falling, etc.)

We worked on a similar project: interfaced with a fitness tracker through bluetooth. Wrote the code to decode bluetooth packets and send commands. Put the code in raspberry-pis connected with a 3G modem, auto-updated, auto-paired with devices, with the actor system. Data went through Kafka. The back-end was in Scala. We had alerts. We had an Android app. We had dashboards in Grafana. A lot of thought went data upload schedules and what to send not to max the data plan, etc. The whole shebang, thousands and thousands of commits.

I was actually hired to the company to design and build that product, interface with the hardware to get the data, etc.

We also wanted to detect falling, and thought about several ways to do that. I set to go directly to the accelerometer's data, and tried to study the change in RSSI with respect to several "base stations" on different planes.

Ask me how many people use it?

We will use the code base for other applications that require streaming data from unattended devices that auto-update and come back to life on their own when they fail.

> He is adamant that we are at the very bottom of the beginning of the curve

Sounds about right. The US is heading for a rough ride, which is made worse by a combination of lack of universal health care and sane coverage being tied to having an employer (or lack thereof of late). To say nothing of leadership (or, there too, lack thereof of late).

That said, the real stories will be sub-Saharan Africa and other poor countries IMO, plus Brazil and India in all likelihood. I'm struggling to imagine Western countries doing the right thing and extending a couple of trillion dollars to poor countries before it completely gets out of hands over there, even though it would be the right thing to do. Short of that, there will be new waves, over and over, until we've a vaccine.

I know BJ Fogg, Stanford behavior scientist, and creator of the Tiny Habits program is doing research into habits and COVID-19. Your brother could reach out to him about this.

https://www.tinyhabits.com/handwashing https://www.tinyhabits.com/stop-touching-your-face https://www.tinyhabits.com/expert-help

Can you put me in direct touch (social distancing understood - but you know what I mean ;-) )
I meant I know he's doing research, I don't personally know him. I'd try his public email, bj@bjfogg.com.
Hi,

I'm an engineer with VA as a part of USDS [https://usds.gov]. As dkhenry stated in the comments, I sent a couple messages to the VA Lighthouse team along with the VA Office of Connected Care team to see they can help support this effort.

I think you should send this as feedback to Apple, specifically the Apple Watch team. Sometimes even emailing the top people at Apple might be able to help.

You can also post this in the iOSprogramming subreddit.

I think this should be possible using the sensors on the watch similar to how watches have the auto screen on when hand is raised.

I’ve found the Apple Watch team to be most responsive in Feedback Assistant, SwiftUI as well.
I’m curious how many vets in AK wear an Apple Watch.

Though I get it that your brother wants to do something.

Agree. Masks in the other hand...we’d be able to save more VA patients if we could somehow convince them (and all of us) to wear masks, and have enough masks to freely give to everyone.
Yeah, I get that “casual” face mask wearing won’t do a lot to protect the wearer from contracting the virus, but if everyone was wearing a masks, that would reduce transmission by know AND unknown carriers. I’m somewhat frustrated wearing masks for this reason is not mandated.
A job of mine involved building prototypes for Wear OS. Based on that I'd guess that the idea is at least explorable.

Smartwatches do have the needed sensors, I think. The watch is in a specific position when you touch your face. That should be detectable.

There is an API to read them, https://developer.android.com/guide/topics/sensors/sensors_m.... You can run apps in the foreground basically infinitely, as long as the Android was not hacked to death by the vendor (and every new Android update might end that in the name of battery efficiency).

One thing to keep in mind is that not every watch has every sensor. Not sure which ones you would need here, but gyroscope and distance should be needed. https://www.mobvoi.com/ge/pages/ticwatchse has both and would be a cheap starting point.

Then this is "just" about creating a model that detects when the watch is in the target position. That might be impossible if I'm wrong about what the sensors return, or complicated if you need to create a complex model where in space the watch is at all time, or it might be rather easy - fully depends on what the sensor data give you and how far Android already interprets them.

Well, what if I wear the watch on my non-dominant hand... and touch my face with my dominant one? Do I then need two watches?
Well, of course.
OpenCV might be a good starting point ... they have facial recognition, and it should be possible to recognize a hand ...
I'd try to get answers to:

- Who will this app be used by?

- What are they doing now?

- How is this app going to help?

- Assuming that the magical technology to detect everything is already available, how exactly will this app do what it does?

- Do they really care enough to take action with the use of this app?

My team and I built this. We tried to make it work on smartwatches, but necessary Hz, battery life, and UX limitations (ie: being in a "fitness session" to access necessary sensors) all proved to be an inadequate user experience. So we just created dedicated hardware and firmware.

Check us out here: https://immutouch.com/

Here's TechCrunch's write up on us: https://techcrunch.com/2020/03/09/dont-immutouch/