An adaptive physiology-aware communication framework for distributed medical cyber physical systems

For emergency medical cyber-physical systems, enhancing the safety and effectiveness of patient care, especially in remote rural areas, is essential. While the doctor to patient ratio in the United States is 30 to 10,000 in large metropolitan areas, it is only 5 to 10,000 in most rural areas; and the highest death rates are often found in the most rural counties. Use of telecommunication technologies can enhance effectiveness and safety of emergency ambulance transport of patients from rural areas to a regional center hospital. It enables remote monitoring of patients by the physician experts at the tertiary center. There are critical times during transport when physician experts can provide vital assistance to the ambulance Emergency Medical Technicians (EMT) to associate best treatments. However, the communication along the roads in rural areas can range irregularly from 4G to low speed 2G links, including some parts of routes with cellular network communication breakage. This unreliable and limited communication bandwidth together with the produced mass of clinical data and the many information exchanges pose a major challenge in real-time supervision of patients. In this study, we define the notion of distributed emergency care, and propose a novel adaptive physiology-aware communication framework which is aware of the patient condition, the underlying network bandwidth, and the criticality of clinical data in the context of the specific diseases. Using the concept of distributed medical CPS models, we study the semantics relation of communication Quality of Service (QoS) with clinical messages, criticality of clinical data, and an ambulance's undertaken route all in a disease-aware manner. Our proposed communication framework is aimed to enhance remote monitoring of acute patients during ambulance transport from a rural hospital to a regional center hospital. We evaluate the components of our framework through various experimentation phases including simulation, instrumentation, real-world profiling, and validation

A Mobile Geo-Communication Dataset for Physiology-Aware DASH in Rural Ambulance Transport

Use of telecommunication technologies for remote, continuous monitoring of patients can enhance effectiveness of emergency ambulance care during transport from rural areas to a regional center hospital. However, the communication along the various routes in rural areas may have wide bandwidth ranges from 2G to 4G; some regions may have only lower satellite bandwidth available. Bandwidth fluctuation together with real-time communication of various clinical multimedia pose a major challenge during rural patient ambulance transport.; AB@The availability of a pre-transport route-dependent communication bandwidth database is an important resource in remote monitoring and clinical multimedia transmission in rural ambulance transport. Here, we present a geo-communication dataset from extensive profiling of 4 major US mobile carriers in Illinois, from the rural location of Hoopeston to the central referral hospital center at Urbana. In collaboration with Carle Foundation Hospital, we developed a profiler, and collected various geographical and communication traces for realistic emergency rural ambulance transport scenarios. Our dataset is to support our ongoing work of proposing "physiology-aware DASH", which is particularly useful for adaptive remote monitoring of critically ill patients in emergency rural ambulance transport. It provides insights on ensuring higher Quality of Service (QoS) for most critical clinical multimedia in response to changes in patients' physiological states and bandwidth conditions. Our dataset is available online for research community.Comment: Proceedings of the 8th ACM on Multimedia Systems Conference (MMSys'17), Pages 158-163, Taipei, Taiwan, June 20 - 23, 201

Physiology-Aware Rural Ambulance Routing

In emergency patient transport from rural medical facility to center tertiary hospital, real-time monitoring of the patient in the ambulance by a physician expert at the tertiary center is crucial. While telemetry healthcare services using mobile networks may enable remote real-time monitoring of transported patients, physiologic measures and tracking are at least as important and requires the existence of high-fidelity communication coverage. However, the wireless networks along the roads especially in rural areas can range from 4G to low-speed 2G, some parts with communication breakage. From a patient care perspective, transport during critical illness can make route selection patient state dependent. Prompt decisions with the relative advantage of a longer more secure bandwidth route versus a shorter, more rapid transport route but with less secure bandwidth must be made. The trade-off between route selection and the quality of wireless communication is an important optimization problem which unfortunately has remained unaddressed by prior work. In this paper, we propose a novel physiology-aware route scheduling approach for emergency ambulance transport of rural patients with acute, high risk diseases in need of continuous remote monitoring. We mathematically model the problem into an NP-hard graph theory problem, and approximate a solution based on a trade-off between communication coverage and shortest path. We profile communication along two major routes in a large rural hospital settings in Illinois, and use the traces to manifest the concept. Further, we design our algorithms and run preliminary experiments for scalability analysis. We believe that our scheduling techniques can become a compelling aid that enables an always-connected remote monitoring system in emergency patient transfer scenarios aimed to prevent morbidity and mortality with early diagnosis treatment.Comment: 6 pages, The Fifth IEEE International Conference on Healthcare Informatics (ICHI 2017), Park City, Utah, 201

A Review on Provisioning Quality of Service of Wireless Telemedicine for E-Health Services

In general, on-line medical consultation reduces time required for medical consultation induces improvement in the quality and efficiency of healthcare services. All major types of current e-health applications such as ECG, X-ray, video, diagnosis images and other common applications have been included in the scope of the study. In addition, the provision of Quality of Service (QoS) for the application of specific healthcare services in e-health, the scheme of priority for e-health services and the support of QoS in wireless networks and techniques or methods for IEEE 802.11 to guarantee the provision of QoS has also been assessed. In e-health, medical services in remote locations such as rural healthcare centers, ambulances, ships as well as home healthcare services can be supported through the applications of e-health services such as medical databases, electronic health records and the routing of text, audio, video and images. Given this, an adaptive resource allocation for a wireless network with multiple service types and multiple priorities have been proposed. For the provision of an acceptable QoS level to users of e-health services, prioritization is an important criterion in a multi-traffic network. The requirement for QoS provisioning in wireless broadband medical networks have paved the pathway for bandwidth requirements and the real-time or live transmission of medical applications. From the study, good performance of the proposed scheme has been validated by the results obtained. The proposed wireless network is capable of handling medical applications for both normal and life-threatening conditions as characterized by the level of emergencies. In addition, the bandwidth allocation and admission control algorithm for IEEE 802.16- based design specifically for wireless telemedicine/e-health services have also been presented in the study. It has been concluded that under busy traffic conditions, the proposed architecture can used as a feasible and reliable infrastructure network for telemedicine

Ubiquitous Computing for Remote Cardiac Patient Monitoring: A Survey

New wireless technologies, such as wireless LAN and sensor networks, for telecardiology purposes give new possibilities for monitoring vital parameters with wearable biomedical sensors, and give patients the freedom to be mobile and still be under continuous monitoring and thereby better quality of patient care. This paper will detail the architecture and quality-of-service (QoS) characteristics in integrated wireless telecardiology platforms. It will also discuss the current promising hardware/software platforms for wireless cardiac monitoring. The design methodology and challenges are provided for realistic implementation

Provisioning Quality of Service of Wireless Telemedicine for E-Health Services: A Review

In general, on-line medical consultation reduces time required for medical consultation and induces improvement in the quality and efficiency of healthcare services. The scope of study includes several key features of present day e-health applications such as X-ray, ECG, video, diagnosis images and other common applications. Moreover, the provision of Quality of Service (QoS) in terms of specific medical care services in e-health, the priority set for e-health services and the support of QoS in wireless networks and techniques or methods aimed at IEEE 802.11 to secure the provision of QoS has been assessed as well. In e-health, medical services in remote places which include rustic healthcare centres, ships, ambulances and home healthcare services can be supported through the applications of e-health services such as medical databases, electronic health data and the transferring of text, video, sound and images. Given this, a proposal has been made for a multiple service wireless networking with multiple sets of priorities. In relation to the terms of an acceptable QoS level by the customers of e-health services, prioritization is an important criterion in a multi-traffic network. The requirement for QoS in medical networking of wireless broadband has paved the way for bandwidth prerequisites and the live transmission or real-time medical applications. The proposed wireless network is capable of handling medical applications for both normal and life-threatening conditions as characterized by the level of emergencies. In addition, the allocation of bandwidth and the system that controls admittance designed based on IEEE 802.16 especially for e-health services or wireless telemedicine will be discussed in this study. It has been concluded that under busy traffic conditions, the proposed architecture can used as a feasible and reliable infrastructure network for telemedicine

Performance Evaluation of an Enhanced Uplink 3.5G System for Mobile Healthcare Applications

The present paper studies the prospective and the performance of a forthcoming high-speed third generation (3.5G) networking technology, called enhanced uplink, for delivering mobile health (m-health) applications. The performance of 3.5G networks is a critical factor for successful development of m-health services perceived by end users. In this paper, we propose a methodology for performance assessment based on the joint uplink transmission of voice, real-time video, biological data (such as electrocardiogram, vital signals, and heart sounds), and healthcare records file transfer. Various scenarios were concerned in terms of real-time, nonreal-time, and emergency applications in random locations, where no other system but 3.5G is available. The accomplishment of quality of service (QoS) was explored through a step-by-step improvement of enhanced uplink system's parameters, attributing the network system for the best performance in the context of the desired m-health services

WEHST: Wearable Engine for Human-Mediated Telepresence

This dissertation reports on the industrial design of a wearable computational device created to enable better emergency medical intervention for situations where electronic remote assistance is necessary. The design created for this doctoral project, which assists practices by paramedics with mandates for search-and-rescue (SAR) in hazardous environments, contributes to the field of human-mediated teleparamedicine (HMTPM). Ethnographic and industrial design aspects of this research considered the intricate relationships at play in search-and-rescue operations, which lead to the design of the system created for this project known as WEHST: Wearable Engine for Human-Mediated Telepresence. Three case studies of different teams were carried out, each focusing on making improvements to the practices of teams of paramedics and search-and-rescue technicians who use combinations of ambulance, airplane, and helicopter transport in specific chemical, biological, radioactive, nuclear and explosive (CBRNE) scenarios. The three paramedicine groups included are the Canadian Air Force 442 Rescue Squadron, Nelson Search and Rescue, and the British Columbia Ambulance Service Infant Transport Team. Data was gathered over a seven-year period through a variety of methods including observation, interviews, examination of documents, and industrial design. The data collected included physiological, social, technical, and ecological information about the rescuers. Actor-network theory guided the research design, data analysis, and design synthesis. All of this leads to the creation of the WEHST system. As identified, the WEHST design created in this dissertation project addresses the difficulty case-study participants found in using their radios in hazardous settings. As the research identified, a means of controlling these radios without depending on hands, voice, or speech would greatly improve communication, as would wearing sensors and other computing resources better linking operators, radios, and environments. WEHST responds to this need. WEHST is an instance of industrial design for a wearable “engine” for human-situated telepresence that includes eight interoperable families of wearable electronic modules and accompanying textiles. These make up a platform technology for modular, scalable and adaptable toolsets for field practice, pedagogy, or research. This document details the considerations that went into the creation of the WEHST design