Interoperable End-to-End Remote Patient Monitoring Platform based on IEEE 11073 PHD and ZigBee Health Care Profile

This paper describes the implementation of an end-to-end remote monitoring platform based on the IEEE 11073 standards for Personal Health Devices (PHD). It provides an overview of the concepts and approaches and describes how the standard has been optimized for small devices with limited resources of processor, memory and power and that use short range wireless technology. It explains aspects of IEEE 11073, including the Domain Information Model, state model and nomenclature, and how these support its plug-and-play architecture. It shows how these aspects underpin a much larger eco-system of interoperable devices and systems that include IHE PCD-01, HL7 and BlueTooth LE medical devices, and the relationship to the Continua Guidelines, advocating the adoption of data standards and nomenclature to support semantic interoperability between health and ambient assisted living (AAL) in future platforms. The paper further describes the adaptions that have been made in order to implement the standard on the ZigBee Health Care Profile and the experiences of implementing an end-to-end platform that has been deployed to frail elderly patients with chronic disease(s) and patients with diabetes.This family of standards is the result of the work of the IEEE Personal Health Devices (PHD) working group and the author acknowledges the contribution of each of the members of the group towards the standards. The Hydra project was funded by the Technology Strategy Board (TSB) and EPSRC, UK. The inCasa project was funded by the European Commission. The Reaction project was funded by the European Commission

A Two-Level Identity Model To Support Interoperability of Identity Information in Electronic Health Record Systems.

The sharing and retrieval of health information for an electronic health record (EHR) across distributed systems involves a range of identified entities that are possible subjects of documentation (e.g., specimen, clinical analyser). Contemporary EHR specifications limit the types of entities that can be the subject of a record to health professionals and patients, thus limiting the use of two level models in healthcare information systems that contribute information to the EHR. The literature describes several information modelling approaches for EHRs, including so called “two level models”. These models differ in the amount of structure imposed on the information to be recorded, but they generally require the health documentation process for the EHR to focus exclusively on the patient as the subject of care and this definition is often a fixed one. In this thesis, the author introduces a new identity modelling approach to create a generalised reference model for sharing archetype-constrained identity information between diverse identity domains, models and services, while permitting reuse of published standard-based archetypes. The author evaluates its use for expressing the major types of existing demographic reference models in an extensible way, and show its application for standards-compliant two-level modelling alongside heterogeneous demographics models. This thesis demonstrates how the two-level modelling approach that is used for EHRs could be adapted and reapplied to provide a highly-flexible and expressive means for representing subjects of information in allied health settings that support the healthcare process, such as the laboratory domain. By relying on the two level modelling approach for representing identity, the proposed design facilitates cross-referencing and disambiguation of certain demographics standards and information models. The work also demonstrates how it can also be used to represent additional clinical identified entities such as specimen and order as subjects of clinical documentation

Design of a secure architecture for the exchange of biomedical information in m-Health scenarios

El paradigma de m-Salud (salud móvil) aboga por la integración masiva de las más avanzadas tecnologías de comunicación, red móvil y sensores en aplicaciones y sistemas de salud, para fomentar el despliegue de un nuevo modelo de atención clínica centrada en el usuario/paciente. Este modelo tiene por objetivos el empoderamiento de los usuarios en la gestión de su propia salud (p.ej. aumentando sus conocimientos, promocionando estilos de vida saludable y previniendo enfermedades), la prestación de una mejor tele-asistencia sanitaria en el hogar para ancianos y pacientes crónicos y una notable disminución del gasto de los Sistemas de Salud gracias a la reducción del número y la duración de las hospitalizaciones. No obstante, estas ventajas, atribuidas a las aplicaciones de m-Salud, suelen venir acompañadas del requisito de un alto grado de disponibilidad de la información biomédica de sus usuarios para garantizar una alta calidad de servicio, p.ej. fusionar varias señales de un usuario para obtener un diagnóstico más preciso. La consecuencia negativa de cumplir esta demanda es el aumento directo de las superficies potencialmente vulnerables a ataques, lo que sitúa a la seguridad (y a la privacidad) del modelo de m-Salud como factor crítico para su éxito. Como requisito no funcional de las aplicaciones de m-Salud, la seguridad ha recibido menos atención que otros requisitos técnicos que eran más urgentes en etapas de desarrollo previas, tales como la robustez, la eficiencia, la interoperabilidad o la usabilidad. Otro factor importante que ha contribuido a retrasar la implementación de políticas de seguridad sólidas es que garantizar un determinado nivel de seguridad implica unos costes que pueden ser muy relevantes en varias dimensiones, en especial en la económica (p.ej. sobrecostes por la inclusión de hardware extra para la autenticación de usuarios), en el rendimiento (p.ej. reducción de la eficiencia y de la interoperabilidad debido a la integración de elementos de seguridad) y en la usabilidad (p.ej. configuración más complicada de dispositivos y aplicaciones de salud debido a las nuevas opciones de seguridad). Por tanto, las soluciones de seguridad que persigan satisfacer a todos los actores del contexto de m-Salud (usuarios, pacientes, personal médico, personal técnico, legisladores, fabricantes de dispositivos y equipos, etc.) deben ser robustas y al mismo tiempo minimizar sus costes asociados. Esta Tesis detalla una propuesta de seguridad, compuesta por cuatro grandes bloques interconectados, para dotar de seguridad a las arquitecturas de m-Salud con unos costes reducidos. El primer bloque define un esquema global que proporciona unos niveles de seguridad e interoperabilidad acordes con las características de las distintas aplicaciones de m-Salud. Este esquema está compuesto por tres capas diferenciadas, diseñadas a la medidas de los dominios de m-Salud y de sus restricciones, incluyendo medidas de seguridad adecuadas para la defensa contra las amenazas asociadas a sus aplicaciones de m-Salud. El segundo bloque establece la extensión de seguridad de aquellos protocolos estándar que permiten la adquisición, el intercambio y/o la administración de información biomédica -- por tanto, usados por muchas aplicaciones de m-Salud -- pero no reúnen los niveles de seguridad detallados en el esquema previo. Estas extensiones se concretan para los estándares biomédicos ISO/IEEE 11073 PHD y SCP-ECG. El tercer bloque propone nuevas formas de fortalecer la seguridad de los tests biomédicos, que constituyen el elemento esencial de muchas aplicaciones de m-Salud de carácter clínico, mediante codificaciones novedosas. Finalmente el cuarto bloque, que se sitúa en paralelo a los anteriores, selecciona herramientas genéricas de seguridad (elementos de autenticación y criptográficos) cuya integración en los otros bloques resulta idónea, y desarrolla nuevas herramientas de seguridad, basadas en señal -- embedding y keytagging --, para reforzar la protección de los test biomédicos.The paradigm of m-Health (mobile health) advocates for the massive integration of advanced mobile communications, network and sensor technologies in healthcare applications and systems to foster the deployment of a new, user/patient-centered healthcare model enabling the empowerment of users in the management of their health (e.g. by increasing their health literacy, promoting healthy lifestyles and the prevention of diseases), a better home-based healthcare delivery for elderly and chronic patients and important savings for healthcare systems due to the reduction of hospitalizations in number and duration. It is a fact that many m-Health applications demand high availability of biomedical information from their users (for further accurate analysis, e.g. by fusion of various signals) to guarantee high quality of service, which on the other hand entails increasing the potential surfaces for attacks. Therefore, it is not surprising that security (and privacy) is commonly included among the most important barriers for the success of m-Health. As a non-functional requirement for m-Health applications, security has received less attention than other technical issues that were more pressing at earlier development stages, such as reliability, eficiency, interoperability or usability. Another fact that has contributed to delaying the enforcement of robust security policies is that guaranteeing a certain security level implies costs that can be very relevant and that span along diferent dimensions. These include budgeting (e.g. the demand of extra hardware for user authentication), performance (e.g. lower eficiency and interoperability due to the addition of security elements) and usability (e.g. cumbersome configuration of devices and applications due to security options). Therefore, security solutions that aim to satisfy all the stakeholders in the m-Health context (users/patients, medical staff, technical staff, systems and devices manufacturers, regulators, etc.) shall be robust and, at the same time, minimize their associated costs. This Thesis details a proposal, composed of four interrelated blocks, to integrate appropriate levels of security in m-Health architectures in a cost-efcient manner. The first block designes a global scheme that provides different security and interoperability levels accordingto how critical are the m-Health applications to be implemented. This consists ofthree layers tailored to the m-Health domains and their constraints, whose security countermeasures defend against the threats of their associated m-Health applications. Next, the second block addresses the security extension of those standard protocols that enable the acquisition, exchange and/or management of biomedical information | thus, used by many m-Health applications | but do not meet the security levels described in the former scheme. These extensions are materialized for the biomedical standards ISO/IEEE 11073 PHD and SCP-ECG. Then, the third block proposes new ways of enhancing the security of biomedical standards, which are the centerpiece of many clinical m-Health applications, by means of novel codings. Finally the fourth block, with is parallel to the others, selects generic security methods (for user authentication and cryptographic protection) whose integration in the other blocks results optimal, and also develops novel signal-based methods (embedding and keytagging) for strengthening the security of biomedical tests. The layer-based extensions of the standards ISO/IEEE 11073 PHD and SCP-ECG can be considered as robust, cost-eficient and respectful with their original features and contents. The former adds no attributes to its data information model, four new frames to the service model |and extends four with new sub-frames|, and only one new sub-state to the communication model. Furthermore, a lightweight architecture consisting of a personal health device mounting a 9 MHz processor and an aggregator mounting a 1 GHz processor is enough to transmit a 3-lead electrocardiogram in real-time implementing the top security layer. The extra requirements associated to this extension are an initial configuration of the health device and the aggregator, tokens for identification/authentication of users if these devices are to be shared and the implementation of certain IHE profiles in the aggregator to enable the integration of measurements in healthcare systems. As regards to the extension of SCP-ECG, it only adds a new section with selected security elements and syntax in order to protect the rest of file contents and provide proper role-based access control. The overhead introduced in the protected SCP-ECG is typically 2{13 % of the regular file size, and the extra delays to protect a newly generated SCP-ECG file and to access it for interpretation are respectively a 2{10 % and a 5 % of the regular delays. As regards to the signal-based security techniques developed, the embedding method is the basis for the proposal of a generic coding for tests composed of biomedical signals, periodic measurements and contextual information. This has been adjusted and evaluated with electrocardiogram and electroencephalogram-based tests, proving the objective clinical quality of the coded tests, the capacity of the coding-access system to operate in real-time (overall delays of 2 s for electrocardiograms and 3.3 s for electroencephalograms) and its high usability. Despite of the embedding of security and metadata to enable m-Health services, the compression ratios obtained by this coding range from ' 3 in real-time transmission to ' 5 in offline operation. Complementarily, keytagging permits associating information to images (and other signals) by means of keys in a secure and non-distorting fashion, which has been availed to implement security measures such as image authentication, integrity control and location of tampered areas, private captioning with role-based access control, traceability and copyright protection. The tests conducted indicate a remarkable robustness-capacity tradeoff that permits implementing all this measures simultaneously, and the compatibility of keytagging with JPEG2000 compression, maintaining this tradeoff while setting the overall keytagging delay in only ' 120 ms for any image size | evidencing the scalability of this technique. As a general conclusion, it has been demonstrated and illustrated with examples that there are various, complementary and structured manners to contribute in the implementation of suitable security levels for m-Health architectures with a moderate cost in budget, performance, interoperability and usability. The m-Health landscape is evolving permanently along all their dimensions, and this Thesis aims to do so with its security. Furthermore, the lessons learned herein may offer further guidance for the elaboration of more comprehensive and updated security schemes, for the extension of other biomedical standards featuring low emphasis on security or privacy, and for the improvement of the state of the art regarding signal-based protection methods and applications

Internet of Things Architectures, Technologies, Applications, Challenges, and Future Directions for Enhanced Living Environments and Healthcare Systems: A Review

Internet of Things (IoT) is an evolution of the Internet and has been gaining increased attention from researchers in both academic and industrial environments. Successive technological enhancements make the development of intelligent systems with a high capacity for communication and data collection possible, providing several opportunities for numerous IoT applications, particularly healthcare systems. Despite all the advantages, there are still several open issues that represent the main challenges for IoT, e.g., accessibility, portability, interoperability, information security, and privacy. IoT provides important characteristics to healthcare systems, such as availability, mobility, and scalability, that o er an architectural basis for numerous high technological healthcare applications, such as real-time patient monitoring, environmental and indoor quality monitoring, and ubiquitous and pervasive information access that benefits health professionals and patients. The constant scientific innovations make it possible to develop IoT devices through countless services for sensing, data fusing, and logging capabilities that lead to several advancements for enhanced living environments (ELEs). This paper reviews the current state of the art on IoT architectures for ELEs and healthcare systems, with a focus on the technologies, applications, challenges, opportunities, open-source platforms, and operating systems. Furthermore, this document synthesizes the existing body of knowledge and identifies common threads and gaps that open up new significant and challenging future research directions.info:eu-repo/semantics/publishedVersio

Internet of things in health: Requirements, issues, and gaps

Background and objectives: The Internet of Things (IoT) paradigm has been extensively applied to several sectors in the last years, ranging from industry to smart cities. In the health domain, IoT makes possible new scenarios of healthcare delivery as well as collecting and processing health data in real time from sensors in order to make informed decisions. However, this domain is complex and presents several tech- nological challenges. Despite the extensive literature about this topic, the application of IoT in healthcare scarcely covers requirements of this sector. Methods: A literature review from January 2010 to February 2021 was performed resulting in 12,108 articles. After filtering by title, abstract, and content, 86 were eligible and examined according to three requirement themes: data lifecycle; trust, security, and privacy; and human-related issues. Results: The analysis of the reviewed literature shows that most approaches consider IoT application in healthcare merely as in any other domain (industry, smart cities…), with no regard of the specific requirements of this domain. Conclusions: Future effort s in this matter should be aligned with the specific requirements and needs of the health domain, so that exploiting the capabilities of the IoT paradigm may represent a meaningful step forward in the application of this technology in healthcare.Consejería de Conocimiento, Investigación y Universidad, Junta de Andalucía P18-TPJ - 307

Controle de fluxo adaptativo para Gateways Bluetooth Low-Energy aplicado a sistemas de monitoramento remoto de pacientes.

O cenário introduzido pela Internet das Coisas potencializa a criação de um novo conjunto de aplicações e serviços, onde diversos dispositivos interagem entre si através da Internet. Esse cenário viabiliza o advento de novas tecnologias de transmissão sem fio de baixo consumo, como o Bluetooth Low-Energy (BLE), as quais viabilizam a criação de redes pessoais (PAN) sem fio. Em paralelo, com a crescente disponibilidade de Dispositivos Pessoais de Saúde com capacidade de comunicação, um cenário onde informações de saúde podem ser disponibilizadas na Internet surge, viabilizando a criação de sistemas de Saúde Conectada. Entretanto, ao viabilizar a criação de redes PAN interconectando diversos dispositivos, a Qualidade de Serviço na rede necessária para o correto funcionamento desses dispositivos de saúde pode ser afetada, dado que redes PAN BLE não oferecem mecanismos para a diferenciação da Qualidade de Serviço entre os dispositivos conectados. Considerando esse contexto de compartilhamento de uma rede PAN entre diversos dispositivos, nesse trabalho propõe-se uma abordagem para o controle do fluxo adaptativo em Gateways BLE utilizando um mecanismo de distribuição de créditos temporal entre os clientes de uma rede PAN. Para essa priorização, informações fornecidas por aplicações são utilizadas para a distribuição e configuração dos parâmetros de conectividade dos dispositivos da rede PAN. Também são apresentados detalhes sobre o projeto e evolução arquitetural do controlador adaptativo, detalhando suas características de controle de fluxo com prioridade temporal. São apresentados resultados experimentais do funcionamento do controlador adaptativo em diferentes cenários. Esses resultados demonstram que o mesmo é capaz de garantir a Qualidade de Serviço de rede necessária para dispositivos específicos em um ambiente compartilhado. Para a validação desse trabalho em um cenário mais amplo, é apresentada uma arquitetura para Sistemas de Monitoramento Remoto de Pacientes padronizado para a Internet das Coisas. Esse sistema serve como base para a implantação e avaliação experimental do controlador de fluxo adaptativo em um Smart-Gateways BLE, onde informações de serviços e aplicações em saúde são utilizadas para priorizar Dispositivos Pessoais de Saúde a depender do seu contexto de uso.The Internet of Things paradigm enables a new set of applications and services to be available in the Internet. This scenario makes possible the development of new low-power communication technologies, such asBluetooth Low-Energy (BLE), which creates wireless Personal Area Networks (PAN). At the same time, the rising availability of Personal Health Devices (PHD) capable of PAN communication and the desire of keeping a high quality of live are the ingredients of the Connected Health vision. However, as the number of PHDs increase, the number of other peripherals connected in the PAN also increases. Therefore, PHDs are now competing for medium access with other devices, decreasing the network Quality of Service of health applications in the BLE PAN, as these networks do not guarantee Quality of Service requirements for connected devices. In this context, where a BLEPAN is shared with multiple devices, it is where this work is immersed. In this work is presented an approach for adaptive flow-control of BLE Gateways using a temporal credit distribution mechanism between clients in a PAN. For this distribution, application context information is used for network prioritization and parameter configuration of PAN devices. In this work is detailed how the adaptive flow-control was designed and how was its architectural evolution, detailing how its temporal mechanism works. Experimental results are presented showing the controller behavior in different scenarios. These results show that using the proposed approach it is possible to guarantee Quality of Service requirements for target devices using a prioritization process in a shared medium. In order to validate this work in a broad scenario, it is also presented a standard-based Remote Patient Monitoring System architecture for the Internet of Things. This system is used as base infrastructure for prioritization of PHDs connections based on their state and requirements by the use of a Smart BLE Gateway. An implementation was developed showing the relevance of the problem and how a BLE adaptive controller can assist in the prioritization of devices in the context of healthcare services and applications.Cape

Modeling medical devices for plug-and-play interoperability

Thesis (M. Eng.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 2007.Includes bibliographical references (p. 181-187).One of the challenges faced by clinical engineers is to support the connectivity and interoperability of medical-electrical point-of-care devices. A system that could enable plug-and-play connectivity and interoperability for medical devices would improve patient safety, save hospitals time and money, and provide data for electronic medical records. However, existing medical device connectivity standards, such as IEEE 11073, have not been widely adopted by medical device manufacturers. This lack of adoption is likely due to the complexity of the existing standards and their poor support for legacy devices. We attempted to design a simpler, more flexible standard for an integrated clinical environment manager. Our standard, called the ICEMAN standard, provides a meta-model for describing medical devices and a communication protocol to enable plug-and-play connectivity for compliant devices. To demonstrate the capabilities of ICEMAN standard, we implemented a service-oriented system that can pair application requirements with device capabilities, based on the ICEMAN device meta-model. This system enables medical devices to interoperate with the manager in a driverless fashion. The system was tested using simulated medical devices.by Robert Matthew Hofmann.M.Eng

An ontology-driven architecture for data integration and management in home-based telemonitoring scenarios

The shift from traditional medical care to the use of new technology and engineering innovations is nowadays an interesting and growing research area mainly motivated by a growing population with chronic conditions and disabilities. By means of information and communications technologies (ICTs), telemedicine systems offer a good solution for providing medical care at a distance to any person in any place at any time. Although significant contributions have been made in this field in recent decades, telemedicine and in e-health scenarios in general still pose numerous challenges that need to be addressed by researchers in order to take maximum advantage of the benefits that these systems provide and to support their long-term implementation. The goal of this research thesis is to make contributions in the field of home-based telemonitoring scenarios. By periodically collecting patients' clinical data and transferring them to physicians located in remote sites, patient health status supervision and feedback provision is possible. This type of telemedicine system guarantees patient supervision while reducing costs (enabling more autonomous patient care and avoiding hospital over flows). Furthermore, patients' quality of life and empowerment are improved. Specifically, this research investigates how a new architecture based on ontologies can be successfully used to address the main challenges presented in home-based telemonitoring scenarios. The challenges include data integration, personalized care, multi-chronic conditions, clinical and technical management. These are the principal issues presented and discussed in this thesis. The proposed new ontology-based architecture takes into account both practical and conceptual integration issues and the transference of data between the end points of the telemonitoring scenario (i.e, communication and message exchange). The architecture includes two layers: 1) a conceptual layer and 2) a data and communication layer. On the one hand, the conceptual layer based on ontologies is proposed to unify the management procedure and integrate incoming data from all the sources involved in the telemonitoring process. On the other hand, the data and communication layer based on web service technologies is proposed to provide practical back-up to the use of the ontology, to provide a real implementation of the tasks it describes and thus to provide a means of exchanging data. This architecture takes advantage of the combination of ontologies, rules, web services and the autonomic computing paradigm. All are well-known technologies and popular solutions applied in the semantic web domain and network management field. A review of these technologies and related works that have made use of them is presented in this thesis in order to understand how they can be combined successfully to provide a solution for telemonitoring scenarios. The design and development of the ontology used in the conceptual layer led to the study of the autonomic computing paradigm and its combination with ontologies. In addition, the OWL (Ontology Web Language) language was studied and selected to express the required knowledge in the ontology while the SPARQL language was examined for its effective use in defining rules. As an outcome of these research tasks, the HOTMES (Home Ontology for Integrated Management in Telemonitoring Scenarios) ontology, presented in this thesis, was developed. The combination of the HOTMES ontology with SPARQL rules to provide a flexible solution for personalising management tasks and adapting the methodology for different management purposes is also discussed. The use of Web Services (WSs) was investigated to support the exchange of information defined in the conceptual layer of the architecture. A generic ontology based solution was designed to integrate data and management procedures in the data and communication layer of the architecture. This is an innovative REST-inspired architecture that allows information contained in an ontology to be exchanged in a generic manner. This layer structure and its communication method provide the approach with scalability and re-usability features. The application of the HOTMES-based architecture has been studied for clinical purposes following three simple methodological stages described in this thesis. Data and management integration for context-aware and personalized monitoring services for patients with chronic conditions in the telemonitoring scenario are thus addressed. In particular, the extension of the HOTMES ontology defines a patient profile. These profiles in combination with individual rules provide clinical guidelines aiming to monitor and evaluate the evolution of the patient's health status evolution. This research implied a multi-disciplinary collaboration where clinicians had an essential role both in the ontology definition and in the validation of the proposed approach. Patient profiles were defined for 16 types of different diseases. Finally, two solutions were explored and compared in this thesis to address the remote technical management of all devices that comprise the telemonitoring scenario. The first solution was based on the HOTMES ontology-based architecture. The second solution was based on the most popular TCP/IP management architecture, SNMP (Simple Network Management Protocol). As a general conclusion, it has been demonstrated that the combination of ontologies, rules, WSs and the autonomic computing paradigm takes advantage of the main benefits that these technologies can offer in terms of knowledge representation, work flow organization, data transference, personalization of services and self-management capabilities. It has been proven that ontologies can be successfully used to provide clear descriptions of managed data (both clinical and technical) and ways of managing such information. This represents a further step towards the possibility of establishing more effective home-based telemonitoring systems and thus improving the remote care of patients with chronic diseases

QoS in Body Area Networks: A survey

Body Area Networks (BANs) are becoming increasingly popular and have shown great potential in real-time monitoring of the human body. With the promise of being cost-effective and unobtrusive and facilitating continuous monitoring, BANs have attracted a wide range of monitoring applications, including medical and healthcare, sports, and rehabilitation systems. Most of these applications are real time and life critical and require a strict guarantee of Quality of Service (QoS) in terms of timeliness, reliability, and so on. Recently, there has been a number of proposals describing diverse approaches or frameworks to achieve QoS in BANs (i.e., for different layers or tiers and different protocols). This survey put these individual efforts into perspective and presents a more holistic view of the area. In this regard, this article identifies a set of QoS requirements for BAN applications and shows how these requirements are linked in a three-tier BAN system and presents a comprehensive review of the existing proposals against those requirements. In addition, open research issues, challenges, and future research directions in achieving these QoS in BANs are highlighted.</jats:p