Smart eHealth Solutions – Closed Loop Health Careusability, security, added value

Helmut Leopold

AIT Austrian Institute of TechnologySafety & Security Department

ETSI, France October, 2011

Medical Infrastructure

Health Care Trends

Increase in life expectancy and

Focus on value added services

Source: Statistik Austria;

Hilfswerk

Modern citizens within the health care system

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expectancy and chronicle diseases

Cost problem

New technologies and processes for health care

services

Citizens take responsibility

Transparency and Information

Health care situation (Austria):

14% persons receiving nursing allowance

11% Home nursing care

Health system expenses increase more rapidly

than GDP!

Smart eHealth: Next Generation eHealth Architecture for Telemedicine – AIT strategy

StandardisationMarket

Penetration

SensorsVital-Data

CommunicationGateway

AnalyticseHealth-

Information System

Doctor + AIT ICT-Expertise � Medical Application

PatientAdded Value

for doctors & patients

Usability Security Medical Added Value

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AIT KeepInTouch (KIT) Set based on NFC technology for easy to use vital parameters measurement

� Highest Usability and data safety� High security� Patient ID (registration)� Blood sugar

• Medicine (Insulin, OAD)• Bread units

� Blood pressure (systolic, diastolic), pulse rate� Weight� Personal feeling & activity

• kind, intensity, duration• Medication

� Reminder and Feedback

Austrian wide Proof of Concept 1: Telemonitoring for Diabetes Mellitus

Workflow - DiabMemory - Gesundheitsdialog

PatientMeasurements (daily / weekly)

� blood sugar� blood pressure� weight

Doctor/ Nurseverification by doctors and nurses

feedback

� weight

Data Collection (parameters)� personal feeling� medication� activity

Data TransferReceiving FeedbackData aggregation: mobile

verification by doctors and nursesdocumentation of the intervention

feedback messages

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Data Centerdata processing (analytics)verification of rulesreminders

Improvement of the Diabetes Therapy …

High values in the morning

� More and updated information� More knowledge on trends� Improved therapy parameters� Efficient patient care

Proof of Concept 2: Telemonitoring for Heart Disease

Workflow - ELICARD

Patient

Doctor / NurseMeasures (daily / weekly)

� blood sugar� blood pressure� weight verification by doctors and nurses

feedback

727/10/2011

Data Center

� weight

Data Collection (parameters)� personal feeling� medication� activity

Data TransferReceiving Feedback

data processingverification of rulesreminders

verification by doctors and nursesdocumentation of the intervention

feedback messages

Successful telemedical intervention for upcoming issues (increase of diuretics)

Improvement of Heart Disease Therapy …

Parameters show changes before affecting the patient

Proof of Concept (POC) - Results

� Acceptance only when added value for

� Patient, doctor and health insurance company

� Validated by doctors

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� Increased health for the patient

� Increased comfort for doctors

� Basis for lowering cost for the health system

Standardization for eHealth and AAL

1027/10/2011

Continua Health Alliance� Continua Health Alliance is a Forum which aims at interoperable products for

health and care� 236 members (mainly CPE manufacturers, operators)� Area of work is personal health with the following subjects:

� Healthcare and Wellness� Aging Independently (main area of AAL)� Chronic Disease Management

� Continua Health Alliance is not a classical standardization body. It promotes

Standardisierung für AAL/eHealth

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� Continua Health Alliance is not a classical standardization body. It promotes available standards and recommends their application. By selecting appropriate standards and options interoperability shall be ensured.

.

Continua Health Alliance – Architecture

Blood Pressure-Monitor

Pulse Oximeter

Medication Dosing Sensor

Phone/mobile Phone

o Supporting family members o Monitoring of elderly o Diet advice o Fitness Coach o Doctor o Data Base

PAN

Appl.

Standardisierung für AAL/eHealth — 12

Glucose Meter

Weighing Scale

Fall Sensor

Gas Sensor

Personal Health System

PC WAN Internet

. . .

Sen-sor LAN

Server

Back-End System

Net Appl.

Server

Continua Health Alliance – Protocollstack PAN-IF/LAN-IF

ISO/IEEE 11073-20601 Optimized Exchange Protocol

ISO/IEEE 11073-10404 Pulse Oxymeter

ISO/IEEE 11073-10407 Blood Pressure Monitor

ISO/IEEE 11073-10408 Thermo-meter

ISO/IEEE 11073-10472 Medicaton Monitor

.......

Standardisierung für AAL/eHealth — 13

IEEE 802.15.4

ZigBee 2007 ZigBee 2007

ZigBee Cluster Library

ZigBee Health Care Profile

Bluetooth

USB

Bluetooth Health Device Profile

USB Personal Healthcare Device Class Specification

PAN-IF (Sensor) -LAN-IF

Health Level Seven International (HL7)

� Health Level Seven International (HL7) is a non-commercial standardization organization which is accepted by ANSI and ISO.� 2300 Members, 57 working groups

� Goal are standards for the exchange, integration, retrieval and common use of electronic information

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retrieval and common use of electronic information within the health sector.

� The name was derived from the OSI protocol model where layer 7 is dedicated to the application (L = level 7; H = Health). Focusing on Data Formats for the exchange of information within eHealth domain� patient data records, insurance data records

� Huge amount of information available!

IHE – Goal

� Goal of IHE is the support of a co-ordinated application of well establishes standards e.g. from DICOM and HL7.

� In order to achieve this, IHE is defining Technical Frameworks for the Implementation of these standards for the message exchange in the clinical area.

� Basis of the Technical Frameworks are Integration Profiles.

Standardisierung für AAL/eHealth — 15

� Basis of the Technical Frameworks are Integration Profiles.� A strict auditing process shall ensure that the Frameworks are

implemented correctly.� Tutorials, training and exhibitions are offered during fairs in order to

demonstrate the advantage of the framework and to support ist application.

� IHE is similar to Continua Health Alliance – application of standards for interoperability for defined use cases – but for the clinical IT domain

� 423 members

ETSI – eHealth activities

ETSI ProjectsETSI Projects

ETSI Technical CommitteesETSI Technical Committees

ATTMAccess, Terminals, Transmission and

Multiplexing

MSGMobile Standards

Group

MTSMethods for Test-ing & Specification

PLTPowerline

TISPANTISPAN

RRSReconfigurable

eHealthCoord.Activities

Health ICT DomainDECT

AEROAeronautics

BRANBroadband Radio Access Network

CLOUDIT-Telecom

Convergence

M2MMachine-to-Machine

Comm.

MCDMedia Content

Distriibution

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ETSI Partnership Projects

ETSI Partnership Projects

BROADCASTEBU/CENELEC/

ETSI on Broadcasting

EEEnvironmentalEngineering

ERMEMC and Radio

Spectrum Matters

ESIElectronic

Signatures and Infrastructures

HFHuman Factors

LILawful Interception

Powerline Telecommuncation

SAFETYSafety

SESSatellite Earth Sta-tions and Systems

STQSpeech Proces-

sing, Transmission & Quality Aspects

Reconfigurable Radio Systems

DECTDigital Enhanced Cordless Telec.

RTRailway

Telecommunic.

SCPSmart Card

Platform

TETRATerrestrial Trunked

Radio

3GPPThird Generation

Partnership Project

Convergence

ITSIntelligent Transport

Systems

INTIMS Network

Testing

ETSI eHealth activities – critical evaluation

� Limited activity of ETSI Project (EP) eHealth

� small number of participants, few working items

� The TC Human Factors (HF) is important, if usability is the major concern

� The TC Machine -to-Machine Communication (M2M) is very

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� The TC Machine -to-Machine Communication (M2M) is very active !

� The basic work (Architecture, Functions, Interfaces) represents an important starting point

� The work-item eHealth within TC M2M should be improved

� The TC EMC and Radio Spectrum Matters (ERM) covers only the limited subject of radio technologies for implants

Open issue for defining a standardization Roadmap� The standardization activities are enormous large and not easy to be

understood by new actors� A standardisation Roadmap should be process- or use-case oriented !� New standardisation activities should be aligned to IHE Integration Profiles � The total number of standards and documents are not manageable for

many eHealth and AAL service operators� Missing concepts for security and privacy� More work is needed to define clear and accepted System-Architecture

� Many technical solutions are in contradiction to national security guidelines (e.g. the remote closing of doors)

� How to deal with person related data, in distributed IT systems and several service operators ? (e.g. location data of individuals)

� Limited NFC activities so far (initial step: NFC Forum has begun defining the use of IEEE 11073 Personal Health Device (PHD)

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Conclusion - Recommendation

� Current available standards, frameworks and profiles are covering eHealth and AAL very well.

� The multitude of bodies and the complexity of the documents require the user to work hard to get familiar with the subject.with the subject.

� Therefore it is now urgent to guide the user to enable him to achieve this.

� No new standardization bodies shall be founded in this area. Instead the application of the existing standards shall be promoted.

Danke !

Merci !

Grazie !

Tack ! Hvala !

Thank

Efcharisto !

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Danke !

Gracias !Köszönom !

Grazie ! Thank You !

AIT Austrian Institute of Technologyyour ingenious partner

DI Helmut LeopoldHead of Safety & Security Departmenthelmut.leopold@ait.ac.at