smart ehealth solutions – closed loop health care · 2011-10-27 · mcd media content...
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Smart eHealth Solutions – Closed Loop Health Careusability, security, added value
Helmut Leopold
AIT Austrian Institute of TechnologySafety & Security Department
ETSI, France October, 2011
Medical Infrastructure
Health Care Trends
Increase in life expectancy and
Focus on value added services
Source: Statistik Austria;
Hilfswerk
Modern citizens within the health care system
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expectancy and chronicle diseases
Cost problem
New technologies and processes for health care
services
Citizens take responsibility
Transparency and Information
Health care situation (Austria):
14% persons receiving nursing allowance
11% Home nursing care
Health system expenses increase more rapidly
than GDP!
Smart eHealth: Next Generation eHealth Architecture for Telemedicine – AIT strategy
StandardisationMarket
Penetration
SensorsVital-Data
CommunicationGateway
AnalyticseHealth-
Information System
Doctor + AIT ICT-Expertise � Medical Application
PatientAdded Value
for doctors & patients
Usability Security Medical Added Value
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AIT KeepInTouch (KIT) Set based on NFC technology for easy to use vital parameters measurement
� Highest Usability and data safety� High security� Patient ID (registration)� Blood sugar
• Medicine (Insulin, OAD)• Bread units
� Blood pressure (systolic, diastolic), pulse rate� Weight� Personal feeling & activity
• kind, intensity, duration• Medication
� Reminder and Feedback
Austrian wide Proof of Concept 1: Telemonitoring for Diabetes Mellitus
Workflow - DiabMemory - Gesundheitsdialog
PatientMeasurements (daily / weekly)
� blood sugar� blood pressure� weight
Doctor/ Nurseverification by doctors and nurses
feedback
� weight
Data Collection (parameters)� personal feeling� medication� activity
Data TransferReceiving FeedbackData aggregation: mobile
verification by doctors and nursesdocumentation of the intervention
feedback messages
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Data Centerdata processing (analytics)verification of rulesreminders
Improvement of the Diabetes Therapy …
High values in the morning
� More and updated information� More knowledge on trends� Improved therapy parameters� Efficient patient care
Proof of Concept 2: Telemonitoring for Heart Disease
Workflow - ELICARD
Patient
Doctor / NurseMeasures (daily / weekly)
� blood sugar� blood pressure� weight verification by doctors and nurses
feedback
727/10/2011
Data Center
� weight
Data Collection (parameters)� personal feeling� medication� activity
Data TransferReceiving Feedback
data processingverification of rulesreminders
verification by doctors and nursesdocumentation of the intervention
feedback messages
Successful telemedical intervention for upcoming issues (increase of diuretics)
Improvement of Heart Disease Therapy …
Parameters show changes before affecting the patient
Proof of Concept (POC) - Results
� Acceptance only when added value for
� Patient, doctor and health insurance company
� Validated by doctors
Standardisierung für AAL/eHealth — 9
� Increased health for the patient
� Increased comfort for doctors
� Basis for lowering cost for the health system
Standardization for eHealth and AAL
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Continua Health Alliance� Continua Health Alliance is a Forum which aims at interoperable products for
health and care� 236 members (mainly CPE manufacturers, operators)� Area of work is personal health with the following subjects:
� Healthcare and Wellness� Aging Independently (main area of AAL)� Chronic Disease Management
� Continua Health Alliance is not a classical standardization body. It promotes
Standardisierung für AAL/eHealth
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� Continua Health Alliance is not a classical standardization body. It promotes available standards and recommends their application. By selecting appropriate standards and options interoperability shall be ensured.
.
Continua Health Alliance – Architecture
Blood Pressure-Monitor
Pulse Oximeter
Medication Dosing Sensor
Phone/mobile Phone
o Supporting family members o Monitoring of elderly o Diet advice o Fitness Coach o Doctor o Data Base
PAN
Appl.
Standardisierung für AAL/eHealth — 12
Glucose Meter
Weighing Scale
Fall Sensor
Gas Sensor
Personal Health System
PC WAN Internet
. . .
Sen-sor LAN
Server
Back-End System
Net Appl.
Server
Continua Health Alliance – Protocollstack PAN-IF/LAN-IF
ISO/IEEE 11073-20601 Optimized Exchange Protocol
ISO/IEEE 11073-10404 Pulse Oxymeter
ISO/IEEE 11073-10407 Blood Pressure Monitor
ISO/IEEE 11073-10408 Thermo-meter
ISO/IEEE 11073-10472 Medicaton Monitor
.......
Standardisierung für AAL/eHealth — 13
IEEE 802.15.4
ZigBee 2007 ZigBee 2007
ZigBee Cluster Library
ZigBee Health Care Profile
Bluetooth
USB
Bluetooth Health Device Profile
USB Personal Healthcare Device Class Specification
PAN-IF (Sensor) -LAN-IF
Health Level Seven International (HL7)
� Health Level Seven International (HL7) is a non-commercial standardization organization which is accepted by ANSI and ISO.� 2300 Members, 57 working groups
� Goal are standards for the exchange, integration, retrieval and common use of electronic information
Standardisierung für AAL/eHealth
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retrieval and common use of electronic information within the health sector.
� The name was derived from the OSI protocol model where layer 7 is dedicated to the application (L = level 7; H = Health). Focusing on Data Formats for the exchange of information within eHealth domain� patient data records, insurance data records
� Huge amount of information available!
IHE – Goal
� Goal of IHE is the support of a co-ordinated application of well establishes standards e.g. from DICOM and HL7.
� In order to achieve this, IHE is defining Technical Frameworks for the Implementation of these standards for the message exchange in the clinical area.
� Basis of the Technical Frameworks are Integration Profiles.
Standardisierung für AAL/eHealth — 15
� Basis of the Technical Frameworks are Integration Profiles.� A strict auditing process shall ensure that the Frameworks are
implemented correctly.� Tutorials, training and exhibitions are offered during fairs in order to
demonstrate the advantage of the framework and to support ist application.
� IHE is similar to Continua Health Alliance – application of standards for interoperability for defined use cases – but for the clinical IT domain
� 423 members
ETSI – eHealth activities
ETSI ProjectsETSI Projects
ETSI Technical CommitteesETSI Technical Committees
ATTMAccess, Terminals, Transmission and
Multiplexing
MSGMobile Standards
Group
MTSMethods for Test-ing & Specification
PLTPowerline
TISPANTISPAN
RRSReconfigurable
eHealthCoord.Activities
Health ICT DomainDECT
AEROAeronautics
BRANBroadband Radio Access Network
CLOUDIT-Telecom
Convergence
M2MMachine-to-Machine
Comm.
MCDMedia Content
Distriibution
1627/10/2011
ETSI Partnership Projects
ETSI Partnership Projects
BROADCASTEBU/CENELEC/
ETSI on Broadcasting
EEEnvironmentalEngineering
ERMEMC and Radio
Spectrum Matters
ESIElectronic
Signatures and Infrastructures
HFHuman Factors
LILawful Interception
Powerline Telecommuncation
SAFETYSafety
SESSatellite Earth Sta-tions and Systems
STQSpeech Proces-
sing, Transmission & Quality Aspects
Reconfigurable Radio Systems
DECTDigital Enhanced Cordless Telec.
RTRailway
Telecommunic.
SCPSmart Card
Platform
TETRATerrestrial Trunked
Radio
3GPPThird Generation
Partnership Project
Convergence
ITSIntelligent Transport
Systems
INTIMS Network
Testing
ETSI eHealth activities – critical evaluation
� Limited activity of ETSI Project (EP) eHealth
� small number of participants, few working items
� The TC Human Factors (HF) is important, if usability is the major concern
� The TC Machine -to-Machine Communication (M2M) is very
Standardisierung für AAL/eHealth
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� The TC Machine -to-Machine Communication (M2M) is very active !
� The basic work (Architecture, Functions, Interfaces) represents an important starting point
� The work-item eHealth within TC M2M should be improved
� The TC EMC and Radio Spectrum Matters (ERM) covers only the limited subject of radio technologies for implants
Open issue for defining a standardization Roadmap� The standardization activities are enormous large and not easy to be
understood by new actors� A standardisation Roadmap should be process- or use-case oriented !� New standardisation activities should be aligned to IHE Integration Profiles � The total number of standards and documents are not manageable for
many eHealth and AAL service operators� Missing concepts for security and privacy� More work is needed to define clear and accepted System-Architecture
� Many technical solutions are in contradiction to national security guidelines (e.g. the remote closing of doors)
� How to deal with person related data, in distributed IT systems and several service operators ? (e.g. location data of individuals)
� Limited NFC activities so far (initial step: NFC Forum has begun defining the use of IEEE 11073 Personal Health Device (PHD)
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Conclusion - Recommendation
� Current available standards, frameworks and profiles are covering eHealth and AAL very well.
� The multitude of bodies and the complexity of the documents require the user to work hard to get familiar with the subject.with the subject.
� Therefore it is now urgent to guide the user to enable him to achieve this.
� No new standardization bodies shall be founded in this area. Instead the application of the existing standards shall be promoted.
Danke !
Merci !
Grazie !
Tack ! Hvala !
Thank
Efcharisto !
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Danke !
Gracias !Köszönom !
Grazie ! Thank You !
AIT Austrian Institute of Technologyyour ingenious partner
DI Helmut LeopoldHead of Safety & Security [email protected]