Managing healthcare transformation towards P5 medicine (Published in Frontiers in Medicine)

Health and social care systems around the world are facing radical organizational, methodological and technological paradigm changes to meet the requirements for improving quality and safety of care as well as efficiency and efficacy of care processes. In this they’re trying to manage the challenges of ongoing demographic changes towards aging, multi-diseased societies, development of human resources, a health and social services consumerism, medical and biomedical progress, and exploding costs for health-related R&D as well as health services delivery. Furthermore, they intend to achieve sustainability of global health systems by transforming them towards intelligent, adaptive and proactive systems focusing on health and wellness with optimized quality and safety outcomes. The outcome is a transformed health and wellness ecosystem combining the approaches of translational medicine, 5P medicine (personalized, preventive, predictive, participative precision medicine) and digital health towards ubiquitous personalized health services realized independent of time and location. It considers individual health status, conditions, genetic and genomic dispositions in personal social, occupational, environmental and behavioural context, thus turning health and social care from reactive to proactive. This requires the advancement communication and cooperation among the business actors from different domains (disciplines) with different methodologies, terminologies/ontologies, education, skills and experiences from data level (data sharing) to concept/knowledge level (knowledge sharing). The challenge here is the understanding and the formal as well as consistent representation of the world of sciences and practices, i.e. of multidisciplinary and dynamic systems in variable context, for enabling mapping between the different disciplines, methodologies, perspectives, intentions, languages, etc. Based on a framework for dynamically, use-case-specifically and context aware representing multi-domain ecosystems including their development process, systems, models and artefacts can be consistently represented, harmonized and integrated. The response to that problem is the formal representation of health and social care ecosystems through an system-oriented, architecture-centric, ontology-based and policy-driven model and framework, addressing all domains and development process views contributing to the system and context in question. Accordingly, this Research Topic would like to address this change towards 5P medicine. Specifically, areas of interest include, but are not limited: • A multidisciplinary approach to the transformation of health and social systems • Success factors for sustainable P5 ecosystems • AI and robotics in transformed health ecosystems • Transformed health ecosystems challenges for security, privacy and trust • Modelling digital health systems • Ethical challenges of personalized digital health • Knowledge representation and management of transformed health ecosystems Table of Contents: 04 Editorial: Managing healthcare transformation towards P5 medicine Bernd Blobel and Dipak Kalra 06 Transformation of Health and Social Care Systems—An Interdisciplinary Approach Toward a Foundational Architecture Bernd Blobel, Frank Oemig, Pekka Ruotsalainen and Diego M. Lopez 26 Transformed Health Ecosystems—Challenges for Security, Privacy, and Trust Pekka Ruotsalainen and Bernd Blobel 36 Success Factors for Scaling Up the Adoption of Digital Therapeutics Towards the Realization of P5 Medicine Alexandra Prodan, Lucas Deimel, Johannes Ahlqvist, Strahil Birov, Rainer Thiel, Meeri Toivanen, Zoi Kolitsi and Dipak Kalra 49 EU-Funded Telemedicine Projects – Assessment of, and Lessons Learned From, in the Light of the SARS-CoV-2 Pandemic Laura Paleari, Virginia Malini, Gabriella Paoli, Stefano Scillieri, Claudia Bighin, Bernd Blobel and Mauro Giacomini 60 A Review of Artificial Intelligence and Robotics in Transformed Health Ecosystems Kerstin Denecke and Claude R. Baudoin 73 Modeling digital health systems to foster interoperability Frank Oemig and Bernd Blobel 89 Challenges and solutions for transforming health ecosystems in low- and middle-income countries through artificial intelligence Diego M. López, Carolina Rico-Olarte, Bernd Blobel and Carol Hullin 111 Linguistic and ontological challenges of multiple domains contributing to transformed health ecosystems Markus Kreuzthaler, Mathias Brochhausen, Cilia Zayas, Bernd Blobel and Stefan Schulz 126 The ethical challenges of personalized digital health Els Maeckelberghe, Kinga Zdunek, Sara Marceglia, Bobbie Farsides and Michael Rigb

pHealth 2021. Proc. of the 18th Internat. Conf. on Wearable Micro and Nano Technologies for Personalised Health, 8-10 November 2021, Genoa, Italy

Smart mobile systems – microsystems, smart textiles, smart implants, sensor-controlled medical devices – together with related body, local and wide-area networks up to cloud services, have become important enablers for telemedicine and the next generation of healthcare services. The multilateral benefits of pHealth technologies offer enormous potential for all stakeholder communities, not only in terms of improvements in medical quality and industrial competitiveness, but also for the management of healthcare costs and, last but not least, the improvement of patient experience. This book presents the proceedings of pHealth 2021, the 18th in a series of conferences on wearable micro and nano technologies for personalized health with personal health management systems, hosted by the University of Genoa, Italy, and held as an online event from 8 – 10 November 2021. The conference focused on digital health ecosystems in the transformation of healthcare towards personalized, participative, preventive, predictive precision medicine (5P medicine). The book contains 46 peer-reviewed papers (1 keynote, 5 invited papers, 33 full papers, and 7 poster papers). Subjects covered include the deployment of mobile technologies, micro-nano-bio smart systems, bio-data management and analytics, autonomous and intelligent systems, the Health Internet of Things (HIoT), as well as potential risks for security and privacy, and the motivation and empowerment of patients in care processes. Providing an overview of current advances in personalized health and health management, the book will be of interest to all those working in the field of healthcare today

Progress in ambient assisted systems for independent living by the elderly

One of the challenges of the ageing population in many countries is the efficient delivery of health and care services, which is further complicated by the increase in neurological conditions among the elderly due to rising life expectancy. Personal care of the elderly is of concern to their relatives, in case they are alone in their homes and unforeseen circumstances occur, affecting their wellbeing. The alternative; i.e. care in nursing homes or hospitals is costly and increases further if specialized care is mobilized to patients’ place of residence. Enabling technologies for independent living by the elderly such as the ambient assisted living systems (AALS) are seen as essential to enhancing care in a cost-effective manner. In light of significant advances in telecommunication, computing and sensor miniaturization, as well as the ubiquity of mobile and connected devices embodying the concept of the Internet of Things (IoT), end-to-end solutions for ambient assisted living have become a reality. The premise of such applications is the continuous and most often real-time monitoring of the environment and occupant behavior using an event-driven intelligent system, thereby providing a facility for monitoring and assessment, and triggering assistance as and when needed. As a growing area of research, it is essential to investigate the approaches for developing AALS in literature to identify current practices and directions for future research. This paper is, therefore, aimed at a comprehensive and critical review of the frameworks and sensor systems used in various ambient assisted living systems, as well as their objectives and relationships with care and clinical systems. Findings from our work suggest that most frameworks focused on activity monitoring for assessing immediate risks while the opportunities for integrating environmental factors for analytics and decision-making, in particular for the long-term care were often overlooked. The potential for wearable devices and sensors, as well as distributed storage and access (e.g. cloud) are yet to be fully appreciated. There is a distinct lack of strong supporting clinical evidence from the implemented technologies. Socio-cultural aspects such as divergence among groups, acceptability and usability of AALS were also overlooked. Future systems need to look into the issues of privacy and cyber security

Cybersecurity and the Digital Health: An Investigation on the State of the Art and the Position of the Actors

Cybercrime is increasingly exposing the health domain to growing risk. The push towards a strong connection of citizens to health services, through digitalization, has undisputed advantages. Digital health allows remote care, the use of medical devices with a high mechatronic and IT content with strong automation, and a large interconnection of hospital networks with an increasingly effective exchange of data. However, all this requires a great cybersecurity commitment—a commitment that must start with scholars in research and then reach the stakeholders. New devices and technological solutions are increasingly breaking into healthcare, and are able to change the processes of interaction in the health domain. This requires cybersecurity to become a vital part of patient safety through changes in human behaviour, technology, and processes, as part of a complete solution. All professionals involved in cybersecurity in the health domain were invited to contribute with their experiences. This book contains contributions from various experts and different fields. Aspects of cybersecurity in healthcare relating to technological advance and emerging risks were addressed. The new boundaries of this field and the impact of COVID-19 on some sectors, such as mhealth, have also been addressed. We dedicate the book to all those with different roles involved in cybersecurity in the health domain

Activity recognition in naturalistic environments using body-worn sensors

Phd ThesisThe research presented in this thesis investigates how deep learning and feature learning can address challenges that arise for activity recognition systems in naturalistic, ecologically valid surroundings such as the private home. One of the main aims of ubiquitous computing is the development of automated recognition systems for human activities and behaviour that are sufficiently robust to be deployed in realistic, in-the-wild environments. In most cases, the targeted application scenarios are people’s daily lives, where systems have to abide by practical usability and privacy constraints. We discuss how these constraints impact data collection and analysis and demonstrate how common approaches to the analysis of movement data effectively limit the practical use of activity recognition systems in every-day surroundings. In light of these issues we develop a novel approach to the representation and modelling of movement data based on a data-driven methodology that has applications in activity recognition, behaviour imaging, and skill assessment in ubiquitous computing. A number of case studies illustrate the suitability of the proposed methods and outline how study design can be adapted to maximise the benefit of these techniques, which show promising performance for clinical applications in particular.SiDE research hu

Un système de collecte sécurisé et de gestion des données pour les réseaux de capteurs sans fils

Le développement des réseaux de capteurs sans fil fait que chaque utilisateur ou organisation est déjà connecté à un nombre important de nœuds. Ces nœuds génèrent une quantité importante de données, rendant la gestion de ces données non évident. De plus, ces données peuvent contenir des informations concernant la vie privée. Les travaux de la thèse attaquent ces problématiques. Premièrement, nous avons conçu un middleware qui communique avec les capteurs physiques pour collecter, stocker, traduire, indexer, analyser et générer des alertes sur les données des capteurs. Ce middleware est basé sur la notion de composants et de composites. Chaque nœud physique communique avec un composite du middleware via une interface RESTFul. Ce middleware a été testé et utilisé dans le cadre du projet Européen Mobesens dans le but de gérer les données d'un réseau de capteurs pour la surveillance de la qualité de l'eau. Deuxièmement, nous avons conçu un protocole hybride d'authentification et d'établissement de clés de paires et de groupes. Considérant qu'il existe une différence de performance entre les noeuds capteur, la passerelle et le middleware, nous avons utilisé l'authentification basé sur la cryptographie basée sur les identités entre la passerelle et le serveur de stockage et une cryptographie symétrique entre les capteurs et les deux autres parties. Ensuite, le middleware a été généralisé dans la troisième partie de la thèse pour que chaque organisation ou individu puisse avoir son propre espace pour gérer les données de ses capteurs en utilisant le cloud computing. Ensuite, nous avons portail social sécurisé pour le partage des données des réseaux de capteursNowadays, each user or organization is already connected to a large number of sensor nodes which generate a substantial amount of data, making their management not an obvious issue. In addition, these data can be confidential. For these reasons, developing a secure system managing the data from heterogeneous sensor nodes is a real need. In the first part, we developed a composite-based middleware for wireless sensor networks to communicate with the physical sensors for storing, processing, indexing, analyzing and generating alerts on those sensors data. Each composite is connected to a physical node or used to aggregate data from different composites. Each physical node communicating with the middleware is setup as a composite. The middleware has been used in the context of the European project Mobesens in order to manage data from a sensor network for monitoring water quality. In the second part of the thesis, we proposed a new hybrid authentication and key establishment scheme between senor nodes (SN), gateways (MN) and the middleware (SS). It is based on two protocols. The first protocol intent is the mutual authentication between SS and MN, on providing an asymmetric pair of keys for MN, and on establishing a pairwise key between them. The second protocol aims at authenticating them, and establishing a group key and pairwise keys between SN and the two others. The middleware has been generalized in the third part in order to provide a private space for multi-organization or -user to manage his sensors data using cloud computing. Next, we expanded the composite with gadgets to share securely sensor data in order to provide a secure social sensor networkEVRY-INT (912282302) / SudocSudocFranceF