A case study in open source innovation: developing the Tidepool Platform for interoperability in type 1 diabetes management.

OBJECTIVE:Develop a device-agnostic cloud platform to host diabetes device data and catalyze an ecosystem of software innovation for type 1 diabetes (T1D) management. MATERIALS AND METHODS:An interdisciplinary team decided to establish a nonprofit company, Tidepool, and build open-source software. RESULTS:Through a user-centered design process, the authors created a software platform, the Tidepool Platform, to upload and host T1D device data in an integrated, device-agnostic fashion, as well as an application ("app"), Blip, to visualize the data. Tidepool's software utilizes the principles of modular components, modern web design including REST APIs and JavaScript, cloud computing, agile development methodology, and robust privacy and security. DISCUSSION:By consolidating the currently scattered and siloed T1D device data ecosystem into one open platform, Tidepool can improve access to the data and enable new possibilities and efficiencies in T1D clinical care and research. The Tidepool Platform decouples diabetes apps from diabetes devices, allowing software developers to build innovative apps without requiring them to design a unique back-end (e.g., database and security) or unique ways of ingesting device data. It allows people with T1D to choose to use any preferred app regardless of which device(s) they use. CONCLUSION:The authors believe that the Tidepool Platform can solve two current problems in the T1D device landscape: 1) limited access to T1D device data and 2) poor interoperability of data from different devices. If proven effective, Tidepool's open source, cloud model for health data interoperability is applicable to other healthcare use cases

Toward an mHealth Intervention for Smoking Cessation

The prevalence of tobacco dependence in the United States (US) remains alarming. Invariably, smoke-related health problems are the leading preventable causes of death in the US. Research has shown that a culturally tailored cessation counseling program can help reduce smoking and other tobacco usage. In this paper, we present a mobile health (mHealth) solution that leverages the Short Message Service (SMS) or text messaging feature of mobile devices to motivate behavior change among tobacco users. Our approach implements the Theory of Planned Behavior (TPB) and a phase-based framework. We make contributions to improving previous mHealth intervention approaches by delivering personalized and evidence-based motivational SMS messages to participants. Our proposed solution implements machine learning algorithms that take the participant\u27s demographic profile and previous smoking behavior into account. We discuss our preliminary evaluation of the system against a couple of pseudo-scenarios and our observation of the system\u27s performance

A Reference Architecture Proposal for Secure Data Management in Mobile Health

Mobile health (mHealth) is becoming a prominent component of healthcare. As the border between wearable consumer devices and medical devices begins to thin, we extend the mHealth definition including sports, lifestyle, and wellbeing apps that may connect to smart bracelets and watches as well as medical device apps running on consumer platforms and dedicated connected medical devices. This trend raises security and privacy concerns, since these technologies collect data ubiquitously and continuously, both on the individual user and on the surroundings. Security issues include lack of authentication and authorization mechanisms, as well as insecure data transmission and storage. Privacy issues include users' lack of control on data flow, poor quality consent management, and limitations on the possibility to remain anonymous. In response to these threats, we propose an advanced reference platform, securing the use of wearables and mobile apps in the mHealth domains through citizens' active protection and information

Amulet: a Secure Architecture for Mhealth Applications for Low-Power Wearable Devices

Interest in using mobile technologies for health-related applications (mHealth) has increased. However, none of the available mobile platforms provide the essential properties that are needed by these applications. An mHealth platform must be (i) secure; (ii) provide high availability; and (iii) allow for the deployment of multiple third-party mHealth applications that share access to an individual\u27s devices and data. Smartphones may not be able to provide property (ii) because there are activities and situations in which an individual may not be able to carry them (e.g., while in a contact sport). A low-power wearable device can provide higher availability, remaining attached to the user during most activities. Furthermore, some mHealth applications require integrating multiple on-body or near-body devices, some owned by a single individual, but others shared with multiple individuals. In this paper, we propose a secure system architecture for a low-power bracelet that can run multiple applications and manage access to shared resources in a body-area mHealth network. The wearer can install a personalized mix of third-party applications to support the monitoring of multiple medical conditions or wellness goals, with strong security safeguards. Our preliminary implementation and evaluation supports the hypothesis that our approach allows for the implementation of a resource monitor on far less power than would be consumed by a mobile device running Linux or Android. Our preliminary experiments demonstrate that our secure architecture would enable applications to run for several weeks on a small wearable device without recharging

Innovations in Monitoring Vital Events:Mobile Phone SMS Support to Improve Coverage of Birth and Death Registration: A Scalable Solution

Civil Registration (CR) of births and deaths is an essential component of any health information system.\ud Globally, across low income countries, CR suffers from unacceptably poor quality coverage. This Health\ud Information Systems Knowledge Hub (HIS Hub) working paper summarises and reports the results, conclusions and outlook from a small six-month project that investigated the potential of introducing a mobile phone step into the routine CR system in a rural district in Tanzania. The project developed a computer application that could receive SMS messages—from existing basic mobile phones of community-based CR officers—and feed them directly to the District Registrar’s office and computer. The message contained the details from the birth or death notification form. The system provided instant access to notifications and automatic feedback to the Village Executive Officer (VEO) if the family that experienced the birth or death event failed to register the event for certification. It also prompted the VEO to follow up with the family by conducting a questionnaire, administered by mobile phone, to determine and communicate the reasons for the non-registration. The District Civil Registrar was also able to monitor trends in these notifications via a user-friendly webbased browser and dashboard. The system was tested for six months and validated against an independent prospective household surveillance system that monitors pregnancies, births and deaths in the same period. In summary, the findings showed that the routine CR system notified only 28% of total births in the period. Adding the SMS step increased this to 51% of births. The routine CR system notified only 2.1% of deaths in the period. Adding the SMS step increased this to 14% of deaths. The SMS step therefore made significant improvements in the notification step (and modest improvements in the registration step) of routine CR. However, both notifications and registrations still fell well short of reality at community level. The most important finding of this pilot is that the current CR system in at least the study district, and likely in most of rural Tanzania, is essentially unable to provide adequate registration coverage for births and deaths, and that coverage is so low that even log order improvements are insufficient to lift it to satisfactory levels (in excess of 90%). This, as yet, says nothing regarding the quality of the data. No overwhelming reason is provided by families for the low reporting rate, suggesting that the problems are highly systemic and will need a radical redesign of CR processes to solve. To the extent that similar problems prevail in other low-income countries, it is clear that whatever these processes will be, some form of scalable real-time mobile communication such as SMS will greatly facilitate coverage levels. This pilot shows\ud that such technology is feasible. But these results also emphasise the need for an end-to-end overhaul of the\ud architecture and processes of how CR systems are built and integrated into the information fabric of a country. Small incremental technical fixes will not suffice\u

Personalized Pain Study Platform Using Evidence-Based Continuous Learning Tool

With the increased accessibility to mobile technologies, research utilizing mobile technologies in medical and public health area has also increased. The efficiency and effectiveness of healthcare services are also improved by introduction of mobile technologies. Effective pain treatment requires regular and continuous pain assessment of the patients. Mobile Health or mHealth has been an active interdisciplinary research area for more than a decade to research pain assessment through different software research tools. Different mHealth support systems are developed to assess pain level of patient using different techniques. Close attention to participant’s self- reported pain along with data mining based pain level detection could help the healthcare industry and researchers to deliver effective health services in pain treatment. Pain expression recognition can be a good way for data mining based approach though pain expression recognition itself may utilize different approach based on the research study scope. Most of the pain research tools are study or disease specific. Some of the tools are pain specific (lumber pain, cancer pain etc) and some are patient group specific (neonatal, adult, woman etc). This results in recurrent but potentially avoidable costs such as time, money, and workforce to develop similar service or software research tools for each research study. Based on the pain study research characteristics, it is possible to design and implement a customizable and extensible generic pain research tool. In this thesis, we have proposed, designed, and implemented a customizable personalized pain study platform tool following a micro service architecture. It has most of the common software research modules that are needed for a pain research study. These include real-time data collection, research participant management, role based access control, research data anonymization etc. This software research tool is also used to investigate pain level detection accuracy using evidence-based continuous learning from facial expression which yielded about 71% classification accuracy. This tool is also HIPAA compliant and platform independent which makes it device independent, privacy-aware, and security-aware

Developing a comprehensive information security framework for mHealth: a detailed analysis

It has been clearly shown that mHealth solutions, which is the use of mobile devices and other wireless technology to provide healthcare services, deliver more patient-focused healthcare, and improve the overall efficiency of healthcare systems. In addition, these solutions can potentially reduce the cost of providing healthcare in the context of the increasing demands of the aging populations in advanced economies. These solutions can also play an important part in intelligent environments, facilitating real-time data collection and input to enable various functionalities. However, there are several challenges regarding the development of mHealth solutions: the most important of these being privacy and data security. Furthermore, the use of cloud computing is becoming an option for the healthcare sector to store healthcare data; but storing data in the cloud raises serious concerns. This paper investigates how data are managed both on mHealth devices as well as in the cloud. Firstly, a detailed analysis of the entire mHealth domain is undertaken to determine domain-specific features and a taxonomy for mHealth, from which a set of security requirements are identified in order to develop a new information security framework. It then examines individual information security frameworks for mHealth devices and the cloud, noting similarities and differences. Furthermore, key mechanisms to implement the new framework are discussed and the new framework is then presented. Finally, the paper presents how the new framework could be implemented in order to develop an Advanced Digital Medical Platform

Mechatronics & the cloud

Conventionally, the engineering design process has assumed that the design team is able to exercise control over all elements of the design, either directly or indirectly in the case of sub-systems through their specifications. The introduction of Cyber-Physical Systems (CPS) and the Internet of Things (IoT) means that a design team’s ability to have control over all elements of a system is no longer the case, particularly as the actual system configuration may well be being dynamically reconfigured in real-time according to user (and vendor) context and need. Additionally, the integration of the Internet of Things with elements of Big Data means that information becomes a commodity to be autonomously traded by and between systems, again according to context and need, all of which has implications for the privacy of system users. The paper therefore considers the relationship between mechatronics and cloud-basedtechnologies in relation to issues such as the distribution of functionality and user privacy