university of west attica, athens, greece department of ......real-time locations systems (rtls)...

University of West Attica, Athens, Greece Department of Biomedical EngineeringBiomedical Technology Laboratory

Prof. Dr.rer.nat Basile Spyropoulos

Biomedical Engineering Department University of West AtticaEmail: [email protected]

ITU Regional Workshop for Europe and CIS on eHealth developmentOdessa, Ukraine, October 17-19, 2018

Towards 5G, IoT and the Modern Hospital

mailto:[email protected]



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ICTs and the modern Hospital

■ The Hospital is the most complex and representativeestablishment of the society, and nowadays, the mostcostly one.

■ ICTs may rationalize personnel-efforts and reduce energyand material-wasting, to enable health-care coverage, ofunprivileged social-groups.

■ This presentation resumes a set of appropriate topics, thatdescribe more or less, the emerging “ICT-driven SmartGreen Hospital”.


ITU Regional Workshop for Europe and CIS on eHealth developmentOdessa, Ukraine, October 17-19, 2018 3

Effective and efficient ICT-means and tools reducing unnecessary Hospitalization cost

■ Mobile IP-networks IETF-standard communication allowing mobile-deviceusers to move from a network to another maintaining IP.

■ Service-oriented architecture, provided to other components by application-components, by a communication protocol, over a network.

■ Ubiquitous-computing appearing anytime and everywhere, by embeddingmicroprocessors into objects, allowing for communication and task-performing.

■ Femtocells, small, low-power cellular base-stations, typically designed for usein a hospital-department, ward-room or unit.

■ Wireless mesh-networks, made-up of radio-nodes, organized in a mesh-topology, supporting intra-hospital data-exchange.

■ Multimedia-sharing over wireless networks for PACS, ICU, Lab etc. data-streaming over IP/wireless-networks.

■ Green-computing in wireless-networks, limiting useless material intra-hospital “circulation”, enabling friendly and smooth procedures.

■ Standardization, policy and regulation for green communications andcomputing and Communication Technologies for “green” buildings.



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ICT-driven Smart Green Hospitals as reflected upon retrieved & evaluated relevant IP-Docs

ICT-DRIVEN SMART GREEN HOSPITALS AS REFLECTED UPON RELEVANT INDUSTRIAL PROPERTY DOCUMENTS

Green buildings; 18Green computing ; 20

Green communi-cation ; 35

Mobile IP networks; 170

Service-oriented architecture; 573

Multimedia-sharing ; 400

Wireless mesh-networks; 379

Ubiquitous-computing ; 59

Femtocells; 1459

Mobile IP networks Service-oriented architecture Ubiquitous-computing

Femtocells Wireless mesh-networks Multimedia-sharing

Green computing Green communication Green buildings



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System and Method for Automatically Switching Based on Cellular Mobile Communication Network IP-Network

System and Method for Automatically Switching Based on Cellular Mobile Communication Network IP-Network. US 20140187240 A1



Femtocell networks: low power and low-cost small base-stations that operate in a licensed spectrum

They usually have coverage of 30-40 meters and use the services of the existing broad-band connection to connect to the operator core network, such as digital subscriber line (DSL).

Left: A typical residential Femtocells Architecture. Using fixed mobile convergence Femtocellsfor alarm reporting, US2009273462 (A1), 2009-11-05. Right: An alarm reporting system andmethod for reporting alarms, to a central monitoring station, via low-power femtocells.



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Α Wireless Mesh Network created by self-organized wireless nodes using multi-hop wireless relaying for data transfer

Left: A typical wireless mesh network diagram, D. Johnson et al., Building a Rural WirelessMesh Network: A do-it-yourself guide to planning and building a Freifunk-based mesh network,Meraka Institute, South Africa. Right: Methods and system to determine the “health” of WMNsare provided, US2017093663 (A1), 2017-03-30.

University of West Attica, Athens, Greece

Department of Biomedical Engineering

Biomedical Technology Laboratory

ITU Regional Workshop for Europe and CIS on eHealth development

Odessa, Ukraine, October 17-19, 20188

Multimedia over Wireless NetworksHospital networks have played an important role in healthcare environment, with new

apps that improve patient care and lead to dropping of unnecessary healthcare costs.

Such networks provide initial

connectivity for a wide range of services,

including:

■ Patient admission and patient recordstracking

■ Electronic Health Records (EHR).■ Wired/wireless communications for

hospital staff.■ Real-Time Locations Systems (RTLS)

(patient monitoring equipment-ICU).◆ Diagnostic imaging RIS, PACS.◆ Laboratory results (LAB).◆ Pharmacy.

Multimedia Traffic

US2011055403 (A1), 2011-03-03, Collaboration agent



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Ubiquitous computing services and applicationsUbiquitous computing envisions a world where embedded processors, computers, sensors, and

digital communications are inexpensive commodities that are available everywhere

Intelligent Mobile & Pervasive computing, Universität Linz - Institut für Pervasive Computing, Software for mobile, ubiquitous and embedded system architectures






Overall architecture for remote patient monitoringAnna-Leena Vuorinen et al., Use of Home Telemonitoring to Support Multidisciplinary

Care of Heart Failure Patients in Finland: Randomized Controlled Trial



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Service Oriented Architecture (SOA) SOA is a style of designing applications in such a way that they are composed of

discrete software agents that have simple and well defined interfaces and are orchestrated through a loose coupling, to perform a required function

Service Oriented Architecture and Business Process Modeling: Before and after SOA.



Green Computing in Wireless Networks“Green antennas” that minimize transmission power of the proximal station.Cloud-computing could become an, however disputable, approach for Green-

computing. Lower consumption sensor-networks and routing-applications have been developed.

Carbon Emission Cloud versus On Premise © Microsoft [INFRARATI: Thoughts on IT Infra-structure/Data Centers, Green IT, IT Virtualization, IT Architecture and IT Modernization].

https://infrarati.wordpress.com/2010/11/07/cloud-computing-is-green-computing/

https://infrarati.wordpress.com/2010/11/07/cloud-computing-is-green-computing/



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Communication Technologies and Standardization for “Green- buildings”

Several attempts to decrease the environmental impact of increased Power consumption



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An overview of the wireless world toward the 5G of wireless/mobile broadband (5G on the Horizon)

https://www.researchgate.net/publication/300484775_Leveraging_SDN_for_the_5G_Networks/figures?lo=1

https://www.researchgate.net/publication/300484775_Leveraging_SDN_for_the_5G_Networks/figures?lo=1



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Need for Green Computing: why should a company promote efficient computing?

■ Microsoft together with Accenture andWSP have conducted a study to thesaving of energy and carbon emissionby cloud computing.

■ They developed a quantitative model tocalculate the energy use and carbonfootprint of the IT applicationsMicrosoft Exchange, Sharepoint andDynamics CRM) for both cloud and on-premise deployment.

■ This approach aligns with theassessment methodology developed bythe Global e-Sustainability Initiative(GeSI).



The ICT-Ecosystem meets-up Health-CareMajor Clinical Departments

■ The Emergency and theOutpatient Departments.

■ The Imaging and the Radio-therapy Departments.

■ The Surgical Departments,the Intensive Care Units(ICU/CCU, NICU etc.) andthe Wards.

■ The in vitro Diagnostics,Hematology, TransfusionMedicine, Cell TherapyLaboratories and Units.

The Supporting Facilities

■ Sterilization & Asepsis.■ Protective clothing and gear.■ Bioactive wastes.■ Laundry.■ Food-services.■ Pharmacy.■ Electro-mechanical Networks.■ Building Engineering etc.



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The pressure on the Life Sciences and AI-powered analytics

■ The pressure on the Life Sciences sector is intense.■ The drive to improve Patient Outcomes, while reducing costs, is

matched by the need to comply with global regulatory changes, whileimproving business and production efficiencies.

■ AI-powered analytics can unlock the Value, in the vast amount of dataLife Sciences organizations generate, to offer the insights to meet thesechallenges.



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Τhe “architecture” of the contemporary Hospital

In a first approach, the Hospital is roughly divided into infive major areas.◆ a) The Emergency (ED) & the Outpatient Departments.◆ b) The Imaging and Radiotherapy Departments.◆ c) The Surgical Departments, the Intensive Care Units

(ICU, CCU, NICU etc.) and the Nursing Wards.◆ d) The in vitro Diagnostics (IVD), the Transfusion Medicine

(TM) and Cell Therapy Laboratories and Units.◆ e)The various Supporting Facilities (e.g. Sterilization,Laundry, Personnel & Patients Food-services, E/MEngineering Facilities, ICTs, Heating & Air-conditioning,Warehouse, Administration etc.).



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Hospitals are the most difficult and complex systems of our society

■ The difficulty or complexity degree, refers to the followingthree major aspects, of combining Biomedical Equipment,already existing Hospital Infrastructure and ICTs.◆ a) Heterogeneity and Scalability of the Devices.◆ b) Low-energy data exchange and tracking.◆ c) Self-organization capability for IoT devices.◆ d) Interoperability and Security.

■ The next Figure, displays an abstractive, however, indicativefor the future “Technology roadmap” for the Internet of Things.

■ In the following paragraphs, we shall attempt to focus on theexisting Hospital technologies and the perspectives of theemerging or at least promising IoT-related innovations, in eachof the mentioned above Hospital areas and Services.



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A technology roadmap of the Internet of ThingsSRI Consulting Business Intelligence, National Intelligence Council



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The Emergency Department

■ The Emergency Department (ED) includes schematically thefollowing sequence of acting:

■ Receiving of an Emergency call or another kind of notification,of an incoming emergency patient.

■ An “IoT-device” can accelerate the identification and theregistration of the patient:◆ By transmitting a first standard message, including forinstance an ID-string.

◆ A social security number.◆ Eventually, a codified preliminary short-description, basedfor instance, on one or two WHO ICD-10/11 assumed codes,over the IoT-device IP, during the transportation.



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The second cardinal step is the “triage”

■ The collection of in Vitro diagnostic (IVD) data, either on site by

employing Point of Care Testing (PoCT) or transmitted from central

Lab over the Autoanalyzer IP.

■ The collection of relevant electrical and non-electrical Biosignals,

acquired on site, digitized and transmitted wirelessly and

simultaneously to the patient-record, to a Decision Supporting Module

(DSM), accelerating the triage-procedure, and finally to the ED-

records.

■ In between Medical Imaging (US, CT, MRI, PET etc.) examinations

are performed on site or elsewhere, and the data are transmitted

wirelessly to the Radiology Information System (RIS) and to the

Picture Archiving and Communication system (PACS), contributing to

the final Diagnosis and the appropriate Treatment, of the ED-patient.



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A modern Emergency Department



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The Outpatient Department (Ambulatorium)■ It offers usually more comfort, privacy and a little bit more time

for the patients, however, the complexity and the severity of theprocedures, leading to a correct Diagnosis and Treatment, is notmuch less pressing, compared to ED.

■ Therefore, the employment of the IoT will bring all theadvantages mentioned previously, providing more time andlower cost.

■ However, additional advantage that can be provided in the verynear future, will be the practically full automation of theContinuity of Care Record (CCR) and the advantages brought,by the use of Semantically enriched XML.

■ It will reduce the paper-work load and will “create” more timefor the physician and the nurse, to be spent for the patients,making medical practice, a little bit more reasonable.



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A typical modern Outpatient Department



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Survey of a London Outpatients Department surveyoflondon.org



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The Imaging & the Radiotherapy Departments

■ The “Medical Imaging IoT” can be traced back over 20 years ago,since the concept of connecting and monitoring medical imagingequipment, via remote servers over the Internet is not new.

■ It has been the corner-stone of the remote servicing capabilities thatMedical Imaging vendors started to offer many years ago.

■ Remote connectivity has allowed for efficiency in equipmentmaintenance and support functions to a service model, adoptingproactive and preventative service.

■ Most Medical Imaging customers, acquire remote services by vendorsthat allow for, early symptoms spotting of an approaching breakdown,minimizing, thus, downtime.

■ Concerning the major “Medical Imaging manufacturers”, they aretaking major steps towards the “next generation” of the Internet of“Medical Imaging Things”.



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Radiology Data

■ Nowdays, a huge amount of Radiology Data are acquired, providingthe opportunity to analyze images and associated objects.

■ Clinical data, far more sophisticated and accurate, are needed toimprove Diagnosis.

■ A huge amount of Radiology & Radiotherapy Data are acquired,providing the opportunity to analyze images, with far moresophisticated and accurate systems, in order to improve diagnosis.

■ The IoT could contribute essentially, to the automation of theevaluation of the accumulated data and their processing, to reach moreaccurate individualized Diagnosis.

■ Further, appropriate arrays of IoT-devices (cyber-actuators) could besoon involved in Radiology, Nuclear Medicine, Ultrasound etc.



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Heuristic methods “merging” the potential ofImaging, Mathematics and IoT related grids

■ Radiology can produce really “BIG” data; however, we need todiscover heuristic methods, by “merging” the potential of Imaging,Mathematics and IoT related grids (or arrays), into a new, almost“robotic” technique.

■ The traditional leading Companies in Radiology have already madetheir own initial preparations, to combine all the necessary aspects ofMedical Imaging with the emerging IoT.

■ Concerning Radiation Therapy, the present and emerging applicationsof IoT are mostly focused on the precision and the accuracy of thedelivered Energy-dose, to the Patient.

■ Equipment connectivity and interoperability was a first priority inRadiotherapy.

■ Since 2013, Varian Medical Systems and Siemens Healthcare, are nowusing Varian-software to plan and manage Radiotherapy treatments,delivered on a Siemens Medical Linear Accelerator.



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The legacy Equipment in RT…



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The present…



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…the future of Proton & C12 Radiotherapy



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Fluorescent nuclear track detectors (FNTDs) Visualization of single-particle traversal in clinical ion beams

■ IoT-devices will replace RFID, in their supporting functions, resultingin further accuracy and precision in RT.

■ Synopsizing, we could remark that, as far as, the technical aspectstaken into consideration, we focus on:◆ The aspects related, to the difficulty degree of this transformation.◆ Medical Imaging and Radiotherapy in the ED and the OutpatientDepartment (OUT) posses a medium heterogeneity and scalabilitydegree.

◆ The Low Energy Data exchange and Tracking, is easily provided inthe Radiology and RT environment.

◆ As far as Self-organization, Interoperability and Security areconcerned, the tasks to be performed constitute still the main obstacle,to achieve a really disrupting influence of IoT, in these two fields.



Device Management and Data Transport in IoT Networks Based on Visible Light CommunicationCheol-Min Kim, Seok-Joo Koh, National University, Daegu 41566, Korea



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The time-dependent evolution of the IoT and the Technologies affecting Hospital the last 10 years



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Surgical Departments Intensive Care Units and the Nursing Wards

■ The Internet of Things promises to turn any object into asource of information about that object.

■ This fact creates a new way, to differentiate products andservices and a new source of value.

■ Admitting a patient for acute-care treatment, unleashes anavalanche of new data:◆ Current vital signs.◆ Patient’s medical history.◆ Reviewing treatment options.

■ All these data may reach to a Diagnosis and to arecommended course of Treatment.



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Common aspects of ICU Surgery and Nursing Wards

■ The two major common aspects of ICU, Surgery and NursingWards are to employ the emerging IoT Technologies, in order tooptimize:◆ The care provided in Emergency situations, in the OperatingRoom and in the Wards.

◆ The safety of the patients during their hospitalization, sincethe hospital environment “kills” by accident, over 50,000people every year, only in the US .

■ The main reason is that still today, a huge number of medicalequipment operates independently and there is no way yet toacquire and process the provided data and information.



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An aspect of the Medical Device Complexity Problem in an ICU



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NYU WIRELESS: Cutting the Cord…Malignant Spaghetti: the mess of wires, monitors and cords necessary for an operating

room to function—but which also make the OR awkward, even dangerous.

NYU WIRELESS will not be focusing solely on medical applications. It is a 5G cellular network, which will be a thousand times faster than what’s available to handheld smart-phones these days.



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Wirelessly linking the sensors in Operating Theater

■ Nevertheless, several providers are developing and offer systems thatwirelessly link the sensors measuring electrical and non electricalBiosignals, in the ED, in the ICU and in the Operating Rooms.

■ These systems aim:■ To reduce the monitoring burden with algorithms spotting correlations

between various Biosignals.◆ To sort out real changes in a condition that requires immediateaction.

■ Therefore, beyond sensors creating data, Artificial Intelligence (AI)tools are needed:◆ That can analyze the vast amount of acquired data.◆ That is able to identify meaningful interrelations, so that betterclinical decisions are made and, thus, the right treatment isprovided.



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IoT-based Information-system for the “non- directlyClinical” Hospital Services

■ IoT-based Information-systems, for the “non-directlyClinical” Hospital Services include:◆ Cleaning Disinfection and Asepsis.◆ In-Hospital Sterilization Services and Outsourcing.◆ Hospital Incineration of Bioactive wastes.◆ Electro-mechanical Networks: Water, Vacuum, PowerSupply, Heating, Air Conditioning etc.

◆ Hospital Patient and Personnel Food Services.◆ Hospital protective clothing-gear Management.◆ Pharmacy: Medicaments, Reagents and Disposables.

■ The non-Clinical Hospital Services have an importantinfluence on the safe and smooth Hospital operation.



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Patent-applications filed concerning Medical Records



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Patent-applications filed concerning Big-Data in Health-Care






Reducing costs through the use of big data…

Crucial Delay-Factors and High-Cost Sources

qEnhanced cognitive-computing based ways toharness, share, manage and trace Big-data.

qInter-operable Electronic Medical Records(EMR).

qReducing costs through use of Big-data.






Predictivity-Proactivity-Personalization-PreventivityExpected to be Ensured by the Big-data Employment…



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Procuring and employing “green” ICT and BMTin the modern Hospital

■ One of the key tasks of the Health-systems is to translateneeds into Health-services, by procuring and employingICT, BMT and other Technologies and Services, in orderto translate them into appropriate facilities, i.e. Hospitalsand other Healthcare Institutions.

■ In Europe there are at least 28 different National Health-systems frameworks, within which public and privateHospitals operate.

■ This multifarious and multifaceted “picture” of Health-care, combined with the explosion of the ICTs, creates a“boom” of interdisciplinary Technologies that are alreadyaltering radically the social reality.



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Reducing costs through the use of Big-data



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A typical Clinical-workflow diagram



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Toward “Smart Room Concepts” for Clinical-workflow: Interoperability & Semantics

■ To move toward new “Smart Room Concepts” for Clinical- workflow,Hospitals must focus on:◆ Αssisting and supporting Nurses, with initiating, updating,following and meeting goals, for Patients’ Care-plans, byleveraging existing and cost-effective technologies.

◆ There are tools that improve the management of Workflow and thetracking of Activity.

◆ Some of these tools, have been around for a while, but they havenot been always seriously adopted and implemented.

■ In the absence of useful technology, Nurses may become very creativeand they have a long history of being very inventive, in absence ofneeded Medical Equipment and Tools.



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A typical “open” Hospital Smart-room



Some of the Smart Room Obstacles

■ Budget constraints, especially outside of Academic Institutions, excludethe way of consistent Innovation, because of shortages in cash-flow.

■ Short term focus-in, instead of investing in long-term strategies,involving the people with the most influence on every day Patients’ Care,the Nurses.

■ Hospitals have to think about the “Smart-room of the “future”, rather asa step-by-step process.

■ This is the reason that Interoperability is so critical, for Equipment andSoftware.

■ We have to continuously build toward the “Smart Room” to be able to addon “modules” and expand over time.

■ Most Hospitals do not have budget and staff to achieve now right awayimplementation, however, many could be ready to take the first steps.

■ The “Smart Room” is not an object that one organization should, or evencould own; it is rather an “array” of various Technologies, Solutions &Companies that can cooperate and integrate, in favor of Patients’ Care.



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Adaptable bathroom design that features a sliding reconfigurable door system based on care needs



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Life Sciences sector has always generated a vast amount of data

■ The Life Sciences sector has always generated a vastamount of data from scientific research, clinical trials,patient profiling, compliance and regulatory requirements.

■ The volume and variety of data continues to grow.■ Estimates suggest that the amount of medical data doubles

every three years.■ As the data provided through new biomedical research,

clinical evidence, epidemiological studies, commercialtransactions and social media increase in speed and size, sodo the challenges of managing and analyzing that data, formaximum Health-care and Business advantage.



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The costs of research and development have grown

■ The costs of research and development have grown while the windowto break even has shrunk.

■ The increasing use of generic drugs is undermining the profit ofbranded medicines and personalized and patient-centric approachesrequire new business models.

■ In addition, tighter regulatory controls and increased worldwideregulatory requirements and costs, place an extra strain on LifeSciences companies.

■ By combining all types of data, such as real-world outcomes data,clinical data, genetic data, demographic data and patient sentimentdata, organizations can gain actionable insight.

■ This translates into more efficient clinical trials, accelerated discoveryand approval of new medicines, improved production and supply chainoperations and more targeted sales and marketing.



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The need for AI-powered analytics

■ Many Life Sciences companies surveyed, said they willstart evaluating AI within the next 12 months.

■ However, more than one-fifth of the companies admitted,did not know, where to begin with implementing thetechnology.

■ For most organizations, this will start with the increasedautomation of key business and production processes.

■ However, the major benefit for Life Sciences companieswill come through the effective combination of AI andanalytics, called AI-powered analytics.



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AI-powered analytics address many of the weaknesses of previous data analytics solutions

■ AI-powered analytics address many of theweaknesses of previous data analytics solutions tomeet today’s big data environment.

■ The majority of analytics solutions used in theindustry are focused on transactions.

■ They provide intelligence into the functioning of day-to-day business process and help retrieve data andbuild reports aimed at improving performance inproduction, maintenance, quality management andaccounting.



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Indicative AI Applications & Use-cases in Healthcare



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Photonics Employment in the SmartHospital-Room

■ Modern Photonics may improve dramatically the smooth operation ofthe “Smart Hospital-Room”, as it is proven in the detailed created“Patent mappings” relating Photonics Technology and Health-care.

■ A patent map is a graphical model of Patent Visualization.■ This practice enables companies to identify the Patents in a particular

technology space, verify the characteristics of these patents, andidentify the relationships among them, to see if there are any zones ofinfringement.

■ Global Patent Maps reveal the Structure of Technological Progress.■ By mapping the way Patents cite each other, network scientists have

been able to study how different technologies, rely on each other andhow new technologies emerge.



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The created Οptics-related Patent-mappings

■ The seven created Figures display Οptics-related Patent-mappings ofIndustrial Property Documents (IP-Docs).

■ The term Photonics, has been developed, as an outgrowth of the firstpractical Semiconductor light emitters, were invented in the ’60s andthe Optical fibers in the `70s.

■ Though covering all light's technical applications over the wholespectrum, most photonic applications are in the range of Visible (VIS)and near-infrared light (NIR).

■ Light sources used in Photonics are usually far more sophisticated thanlight bulbs.

■ Photonics commonly use Semiconductor Light-sources like Light-Emitting Diodes (LEDs), Super Luminescent Diodes, and LASERs.



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Results of a Patent-search concerning LASERs and Photonics (1960-2017) performed by the EPO search-engine esp@cenet



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Results of a Patent-search, concerning important aspects of LASERs and Photonics Industrial applications



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Numbers of IP-Docs concerning the most important Light Sources



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Numbers of IP-Docs concerning Light Transmission media



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Relevant and potentially innovative IP-Docs related to modern Optical Communications.



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Numbers of IP-Docs related to Optical Amplifiers



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Concluding remarks

■ We are all already moving toward the big-data driven “smart”and “green” Hospital and Health-care in general, with differentstarting-points and speeds and all of us carrying the burden ofour historical, cultural and political tradition.

■ A number of Healthcare indicators are being shifted from the20th Century centralized model toward the 21st Century“networked-Society”, wired or wireless, spread and multi-faceted model.

■ The social and cultural versatility of our global society is newand much promising; however, it constitutes a rather terrifyingemerging environment.

■ The Hospital, is an important ancient “progress flagship”.■ Nowadays, it is more than ever in the human History, the most

complex and concurrently the most representative system, thissociety has given birth to…



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Thanks for your Patience…