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					   From Cards to Portable Devices and Sensor
Networks for Wireless Personalized Health Services
   Peter Pharow1, Françoise Petersen2, Asbjørn Hovstø3, Fritz Meier4, Qiang Pan5, Pekka Ruotsalainen6, Tomáš
                                                 Trpišovský7
                                   1
                                       eHealth Competence Center, Regensburg University Hospital
                                                       Regensburg, Germany
                                                           <peter.pharow@web.de>
                                                                   2
                                                                   Apica/ETSI
                                                             Sophia-Antipolis, France
                                                     <francoise.petersen@apica.com>
                                                                   3
                                                                    ITS Norway
                                                                   Oslo, Norway
                                                        <ITS_Expert@its-norway.no>
                                       4
                                           Zentrum für intelligente Objekte ZIO, Fraunhofer IIS-ATL
                                                             Nuremberg, Germany
                                                    <fritz.meier@atl.fraunhofer.de>
                                                  <alexander.pflaum@atl.fraunhofer.de>
       5
           Key Laboratory of WSN and Communication, Shanghai Institute of Microsystem and Information Technology
                                      Chinese Academy of Sciences, Shanghai, China
                                                           <qpan@mail.sim.ac.cn>
                                                           <xingt@mail.sim.ac.cn>
                              6
                                  Information Department, National Institute for Health and Welfare
                                                        Helsinki, Finland
                                                       <Pekka.Ruotsalainen@THL.fi>
                                              7
                                                  Institut mikroelektronických aplikací (IMA) s.r.o.
                                                               Prague, Czech Republic
                                                         <Tomas.Trpisovsky@ima.cz>

Abstract— Modern health care systems aim to involve both                    of complex information handing infrastructures. It has been a
health professionals and citizens. Citizens thus enabled to take            long journey from plastic cards to chip cards to the
greater responsibility for their own healthcare. Technologies               personalized portable devices that are just on the horizon [1].
like Internet, mobile phones, sensors, etc. enable patients to                  Sensors and sensor networks help to deliver health
actively participate in health care processes. Personalization of           services and collect patient-related medical information.
health services based on the application of portable devices,               Personalized portable (wireless) devices play an important
sensors and actuators offers a real opportunity for practicing              role in the context of modern Health Information Systems
high quality wireless personalized shared care.                             and the pathway towards “wireless patients”.
The seminar jointly organized by EFMI WG “Personal
                                                                                Today’s commonplace devices are often “security
Portable Devices (PPD)” and ISO/IEC JTC 1 “Study Group on
Sensor Networks (SGSN)” aims at identifying criteria/factors
                                                                            tokens” that enable access to remote data; or they might
determining the application of personalized portable devices,               carry medical information (e.g. a basic set of emergency
sensors, and actuators for wireless networked health care and               data, allergies, vaccination records, specific indications such
welfare service provision. The topics are based on experiences              as diabetes).
from national, EU, and international projects, emerging                         In addition to these “traditional” approaches, new
standardization activities, and existing and emerging routine               opportunities arise from the establishment of personal
implementations in the domain of personal health care.                      portable wireless sensors. Specific networks for sensors can
                                                                            be implemented for data capturing and data analysis.
                     I.   INTRODUCTION                                          Advanced standardization both from a technical and an
    Cards of some form have been widely used in health care                 administrative perspective is underway enabling a significant
for about 40 years. The European Health Insurance Card                      level of harmonization and interoperability of solutions
(EHIC) is being introduced in almost all countries within the               nationally, in Europe, and worldwide [2].
EU; an electronic version (eEHIC) is under standardization.
However, cards and other secure tokens are just single pieces
           II. PERSONALIZED HEALTH SERVICES                      changed in a predictable way according to the current
    Personal Health (pHealth) focuses on citizen-centric         situation without human intervention in response to a change
personalized health service provision. Wearable or portable      of situation.
technologies for personalized health (cards, chips, tokens,
mobile phones, sensors, actuators, etc.) are considered first        A typical person using the profile system will have two
line communication tools [3]. They provide:                      key roles – the “user” role that allows minimal (or even no
     Identification management, personalization, access         manual) access to profile data and the “administrator” role
                                                                 that enables greater access to the controlling parameters in
       control, insurance, reimbursement, and entitlement;
                                                                 the profiles. It is likely that some people, for instance very
     Security, privacy and trustworthiness of health            young children, would not be allowed (e.g. by parents) the
       service delivery;                                         administrator role.
     Secure and reliable access to vital signs (parameter           Some people will have a role in managing another
       data) in routine use as well as in case of emergency;     person’s profile (e.g. a parent may manage the profiles of
     up-to-date personal health data from everywhere            their children or a carer may help a client to manage their
       anytime.                                                  profile). Some people will therefore have an administrator
                                                                 role for a profile that is not directly associated with them. In
   Patients increasingly prefer to stay in their everyday        addition to these two basic profile related roles, there is a
environment (home, work, etc.) rather than being                 need to identify roles within the eHealth domain, such as the
hospitalized. P-Health supports this through systems that can    most basic roles:
be personalized to fit the needs of patients and carers.              Client: The individual receiving the eHealth service.
Personalization, such as personal preferences and individual          Carer: included in this category are both professional
profiles, can enhance a person’s trust in the system, and                 and informal carers such as relatives, neighbors,
make it more readily accepted.                                            friends or volunteers providing care for the person in
                                                                          need.
A. Personalization Objectives
    Personalization and effective profile management will be           III. COLLABORATIVE INFORMATION PROCESSING
critical to the uptake of eHealth systems. This can range            Sensor networks have great potential in providing
from simply setting an alarm volume according to the             personalized services for chronic disease management,
person’s hearing abilities and the ambient noise level, to the   personal wellness monitoring and physical fitness tracking.
complex tailoring of an entire p-Health environment. The         Collaborative information processing (CIP), in which raw
unique approach to achieve the goals of personalized systems     sensor data are collected, aggregated and fused into high-
is the combination of three important areas: standardization     level information on the physical objects/world, must be
of Information and Communications Technologies (ICT);            carefully designed to meet challenges in sensor networks
Human Factors; and eHealth.                                      from both the networking and information sensing
    The Human Factors and eHealth Technical Bodies of the        perspectives.
European Telecommunications Standards Institute (ETSI)
[4] have created two specialist task forces: STF 342 [5]         A. CIP Challenges in Sensor Networks
which specifies the architecture for personalization and user        The ultimate goal of sensor networks is not just
preferences in general; and STF 352 [6] which standardizes       measurement, but the creation of usable information or
the information and preferences for personalization of           knowledge. Sensor networks have to meet challenges such as
eHealth systems in particular.                                   constrained resource, incomplete and inconsistent
B. User Profiles for Personalization                             information from individual sensors, and deliver integrated
                                                                 service provision often in an environment that is less than
   The personalization is achieved by maintaining and            ideal because of noise, interference and unstable
updating a profile, which depends on and is dynamically          communication links.
adapted, to the individual’s context, general preferences,
physical and mental abilities, etc. The profile can then be      B. Modeling of CIP in Sensor Networks
used by eHealth services and devices to ensure a consistent          A three-dimension CIP classification model is proposed.
experience irrespective of context.                                  In the Processing Level dimension, a CIP can be
   The work builds on the personalization and user profile       described in terms of data, feature and decision processing
concept described in the ETSI guide EG 202 325 [7].              levels. Involved Entities in a CIP (second level) could be
C. Profile Categories and User Roles                             sensor modalities, processing modules, nodes, clusters, and
                                                                 even subnets. The CIP can thirdly be viewed from
    A profile provides information, preferences and rules        Component Task dimension which depends on the specific
applicable at a given time and typically includes several        use cases and the related application scenarios of sensor
inter-related data items. A profile might be such as “At         networks.
Home”, “At the Hospital”, “Out”…”.                                   In health care context, Component Tasks may include
    Maximum benefit from profiles will only occur if the         blood pressure/temperature measurement, respiration
values of related profile items can be simultaneously            inspection, and gait analysis. In an anti-intrusion application,
target detection, classification, and tracking could be                                                                  historical health record, healthcare information collected in
component tasks for security services.                                                                                   real-time, life-style and location information, sleeping data
                                                                                                                         and signals received by implanted nano-sensors.
C. CIP Implementation Framework                                                                                              This might take place without the person being aware of
    Figure 1 presents a generic implementation framework of                                                              the extent of monitoring. But whilst information collected
CIP in sensor networks. In this framework, three main                                                                    and pre-processed by PPDs is a necessary enabler for
entities, named Capability Declaration, Collaborative                                                                    pHealth it creates new security and privacy protection needs.
Strategy Planning, and Communication Requirement                                                                             It is therefore necessary to enable the subject of
Specification, are defined.                                                                                              information to control the use and disclosure of information
                                                                                                                         collected via his/her PPDs. The successful use of PPDs in
Information Service User
                                                           Service
                                                         Specification
                                                                                                       High Level
                                                                                                    Data / Information
                                                                                                                         pHealth applications sets up new requirements both for the
                                                                                                                         security infrastructure and the information models used with
Information Service Provider                                                                                             PPDs.

                                                         Centralized
                                                                                                                         B. NFC Mobile Phones for Health Service Personalization
                                                         Computing
     Capability               Collaborative                                        Communication      Collaborative          One aspect of applying nano and micro technology to the
                                                                                                      Information
     Declaration            Strategy Planning                                       Requirement
                                                                                    Specification      Processing        domain of health care in general and to the pHealth domain
                                                         Distributed                                      (CIP)

 Capability Evaluation                                   Computing                                                       in particular, reflects the utilization of recent RFID, NFC and
                           Local Measurement
                                  &
                            Node Properties
                                                                                                                         ZigBee technologies in the large scale eID systems [8].
                                                    Computing Paradigm
                                                                                                                             Contactless technology opens several opportunities for
                                                                                                                         misuse of personal information and generates concerns about
                                          Communication and Information Exchange
                                                                                                       Low Level
                                                                                                    Data / Information
                                                                                                                         privacy protection. However, not all information is
                                                                                                                         concerned with people. Other objects have to be identified,
 Fig. 1 A Generic CIP Implementation Framework for Sensor Networks                                                       such as medicines, equipment in hospitals, biological
                                                                                                                         samples etc. These can be “tagged” with machine-readable
    The Capability Declaration Entity (CDE) declares                                                                     devices. These devices might be passive or active.
capabilities of one sensor node to other nodes. The                                                                          In this context an NFC handset seems an important tool
Collaborative Strategy Planning Entity (CSPE) forms global                                                               enabling GSM connectivity and on-site secure and
or regional maps and scopes on signal and information                                                                    communication with the sensors disseminated in the human’s
processing problems. With certain cost functions or utility                                                              personal environment.
measures, CSPE finds a resource-efficient solution to                                                                        In the health domain, this could include GSM-enabled
achieve preferred information processing performance.                                                                    “panic buttons” (for medical or other emergencies), or GSM
    The Communication Requirement Specification Entity                                                                   “hubs” to manage related collections of information e.g.
(CRSE) acts as interface to the underlying Communication                                                                 management of groups of patients or prompt localization of
and Information Exchange layer. It defines parameters,                                                                   emergency health equipment in health care settings.
languages or protocols of requirements on communication
and information exchange allowing a successful implemen-                                                                 C. Intelligent Transportation System Services
tation into device and sensor networks for various purposes.                                                                 Intelligent Transport Systems (ITSs) utilize combinations
                                                                                                                         of computers, communication networks as well as new
                 IV. APPLICATIONS ASPECTS                                                                                positioning and automation technologies that collect and
    Before applying personal portable devices, sensors,                                                                  generate data in order to relieve traffic congestion, to ensure
actuators, and other medical equipment it is essential to                                                                safety and to protect the environment, while providing
address the human and environmental factors. These include                                                               transport related services and applications [9].
ensuring appropriate personalization and role management;                                                                    In terms of pHealth applications, ITS facilitate and
proper information capture and processing; and the human                                                                 manage the interaction of
actions to be taken in given circumstances.                                                                                   emergency vehicles which can be located, identified,
    This will be highlighted in the following chapter.                                                                            assessed and controlled using ITS;
                                                                                                                              people who employ ITS for navigation,
A. Health Service Security and Privacy in future pHealth
                                                                                                                                  entertainment, travel information and their
    The paradigm change from “cure” to “prevent” is under                                                                         monitoring capabilities;
way. Major targets for p-health are early detection of illness                                                                external information such as reports of emergencies.
and changes in functionality, prediction and pro-active                                                                      As a special aspect of tracking the position of vehicles,
prevention of diseases. By 2020 ubiquitous care is expected                                                              ITS can help identifying the position of vehicles transporting
to be reality in secondary, primary and personal care settings.                                                          tissues, organs, blood bag, drugs, medical equipment, and
Pro-active prevention and (personal) health and wellness                                                                 other goods important for health services delivery.
prediction services require much wider information than is
collected and available today.                                                                                           D. Sensor Networks for Optimization of Blood Bag Access
    The future ubiquitous PPDs make it possible to collect                                                                  Wireless sensor networks (WSN) can help hospitals and
and collate any kind of personal information such a person’s                                                             ambulances increase efficiency and cost-effectiveness while
maintaining high quality care. In the project OPAL Health        establish a more formal collaboration (liaison) and foresee
WSN is used to support the handling of blood bags. The           joint appearances at various events in the interest of both
process relevant to p-health is the in-house process from the    organizations. Both groups expressed their vast interest in
blood depot to the patient in need.                              joining their activities, when applicable, and invited the
    Simplified, the process can be described as follows: A       ETSI Technical Bodies eHealth and Human Factors (HF) to
department orders blood bags for a patient and the blood         collaborate and to actively contribute.
bank supplies the department with the right amount of blood.
The department stores the blood bags until they are needed.                          ACKNOWLEDGEMENT
Some blood bags will be used. The blood bags will be sent
                                                                     The seminar has jointly been organized by the EFMI WG
back to the blood bank, whether empty or not, to be disposed
                                                                 “Personal Portable Devices” and the ISO/IEC JTC 1 “Study
or used again [10]. The following benefits can be achieved
                                                                 Group on Sensor Networks” supported by the European
with WSN supporting:
                                                                 Telecommunications Standards Institute. The speakers thank
     Further enhance patient safety through active process      these organizations for their support. The authors thank their
        quality management;                                      colleagues Bernd Blobel, Paul Cheshire, Alexander Pflaum,
     Avoidance of wasting blood products while                  Mike Pluge, Torbjørn Sund, and Tao Xing. They thank their
        maintaining quality standards;                           institutions and companies as well as their colleagues from
     Enhance availability of blood products;                    CEN, IEEE, ITU, ICAO, HL7, OMG, and other SDOs.
     Automation or simplification of documentation.                 The project “OPAL Health” has been funded by the
    Most countries have strict rules about handling blood        German Federal Ministry of Economics and Technology
products and a WSN can enforce the compliance of these           under the Simobit research program (FKZ 01MB07016).
rules.                                                               The work on eHealth personalization is performed at the
                                                                 European Telecommunications Standards Institute (ETSI) by
                 V. SEMINAR CONCLUSIONS                          the members of the Specialist Task Force (STF) 352 under
    Personalized portable devices, sensors and actuators as      the guidance of the ETSI Technical Bodies HF (Human
well as the underlying networks enable personalized health       Factors) and eHealth. The task of an STF is to accelerate the
service provision. Applications from other domains stimulate     standardization process in areas of strategic importance and
the respective paradigm shift also in the healthcare and         in response to urgent market needs [11]. The work on
welfare domain. The seminar on the paradigm shift from           personalization is co-financed by the EC/EFTA in response
health cards to personalized devices and sensor networks for     to the EC’s ICT Standardization Work Programme.
providing personal health services addressed technical,
medical, organizational, legal, and standardization aspects of                               REFERENCES
portable devices (EFMI WG PPD) and sensor networks               [1]  Cheshire P: “Ambient Technology in Care Services” – the Role of
(ISO/IEC JTC1 SGSN). Facilitated by domain experts                    PPDs. World eID 2006, Sophia Antipolis, September 2006.
presenting their different views, the seminar allowed all        [2] Pharow P, Blobel B: Mobile Health Requires Mobile Security –
                                                                      Challenges, Solutions, and Standardization. In: Andersen S.K., Klein
attendees a comprehensive look into the present and the near          G.O., Schulz S., Arts J., Mazzoleni M.C. (Edrs.): eHealth Beyond the
future of personal health service provision supported by              Horizon – Get IT There. Proceedings of MIE 2008. Series Studies in
devices of any technology, any kind and any size either               Health Technology and Informatics, Vol. 136. IOS Press, Amsterdam,
directly applied to the human body, or placed even inside the         Berlin, Oxford, Tokyo, Washington 2008.
body.                                                            [3] Blobel B, Pharow P, Norgall T. How to Enhance Integrated Care
                                                                      towards the Personal Health Paradigm? In: Kuhn KA, Warren JR,
    A system dedicated to support personal health service             Leong T-Z (Edrs.): MEDINFO 2007, pp. 172-176. IOS Press
provision can help people to live an independent life in their        Amsterdam, Berlin, Oxford, Tokyo, Washington, DC, 2007.
normal environment. As consequence, their context will be        [4] European Telecommunications Standards Institute (ETSI),
much more variable than when they are institutionalized.              http://www.etsi.org.
                                                                 [5] User Profile Management: ETSI Specialist task force 342.
Since the appropriate reaction in one context can be                  http://portal.etsi.org/STFs/STF_HomePages/       STF342/STF342.asp
ineffective or even detrimental in another context, the               (last accessed: May 14th, 2009).
pHealth system identifies and then reacts according to           [6] eHealth User Profiles: ETSI Specialist task force 352.
context.                                                              http://portal.etsi.org/STFs/STF_HomePages/       STF352/STF352.asp
      The domain of personalizing health services includes            (last accessed: May 14th, 2009).
                                                                 [7] ETSI EG 202 325: 2005, Human Factors (HF); User Profile
the proper and seamless application of devices, sensors, and          Management, ETSI, Sophia-Antipolis.
actuators. Components are available by now; others are           [8] .Draft Standard for Smart Transducer Interface for Sensors and
thinkable or even realizable in the near future.                      Actuators – Transducers to Radio Frequency Identification (RFID)
                                                                      Systems Communication Protocols and transducer Electronic Data
    But despite the amazing supportive technical tools now            Sheet Formats. IEEE P1451.7.
available, the human factors and face to face communication      [9] Hovsto A, Pharow P, Blobel B: How to Achieve Sustainability in
remain a must in health care.                                         Advanced eHealth Sensor-based Systems. Conference Proceedings
      As most of the seminar attendees were very much                 13th International ITA Workshop, Kraków, June, 2008.
interested in closely following the progress of applied               http://www.itw2008.pl/papers/ITW2008proceedings.pdf.
                                                                 [10] ISO/IEC JTC1 SGSN: Creating Ubiquitous Services with Sensor
personalized devices and sensor networks, representatives of          networks. Document SGSN N059.
EFMI WG PPD and ISO/IEC JTC 1 SGSN planned to
[11] ETSI Specialist   Task   Forces,   http://portal.etsi.org/stfs/process/
     home.asp

				
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