Recent advances in standard-based solutions for Personal e-Health

1. x73
up Health.ES
Spain
Groupx73
up Health.ES
Spain
Group
X73 Spain Group
Recent Innovative Advances
lin Biomedical Engineering:
Standard-based Designg
for Ubiquitous p-Health
J.Escayola, I. Martínez, J.D. Trigo,
M. Martínez-Espronceda,
S. Led, L. Serrano, J. Garcíad, a , a a
[imr, jtrigo@unizar.es,
miguel.martinezdeespronceda
@unavarra.es]
x73
up Health.ES
Spain
Group
ICCGI
2009

2. x73
up Health.ES
Spain
Group
from e Health to p Health
Personal Health Solutions 
from e-Health to p-Health
‫ﺣ‬ Evolution of Point-of-Care location
◦ The healthcare process changes its location from hospital/health centre to user/patient
[ICUs/Point-of-Care (PoC)  Patient/Personal Health Devices (PHD)][ICUs/Point of Care (PoC)  Patient/Personal Health Devices (PHD)]
◦ New ubiquitous networks: Homing (HAN), Personal (PAN), Body (BAN) Area Networks
[New Medical Devices (MDs) and Use Cases (UCs)]
◦ Evolution of TICs  new paradigm of the telemedicine serviceso ut o o Cs e pa ad g o t e te e ed c e se ces
[home/e-Health  mobile/m-Health  ubiquitous/u-Health  personal/p-Health]

3. x73
up Health.ES
Spain
Group
pilot projects
Personal Health Solutions 
pilot projects
‫ﺣ‬ Biomedical Wireless Sensor BWSN
Developed in Norway and Sweden with the collaboration
of Rikshospitalet-Radiumhospitalet HF and enterprises
‫ﺣ‬ U-R-SAFE
European project coordinated with France, Alcatel e
R D E I tit t F d t t l /t l(Ericsson, Millicore, Novosense). Sensor wireless network
with application in remote monitoring (priority to patient
mobility and personal auto-control). The included MDs
are: electrocardiogram (ECG), blood pressure, chemical
( l ) b h
R+D European Institutes. Focused to telecare/tele-
monitoring of elderly patients. The patient establish a
connection via wireless public network (GPRS, UMTS
and/or satellite). The included MDs are:
l t di (ECG) S O2 f ll d t tsensors (glucose), breathe, temperature.
1 Ultra Wide Band
Net ork
electrocardiogram (ECG), SpO2 sensor, fall detector.
4
Fall Detector
Network
Personal Base Station
SpO2 sensor ECG Sensor

4. x73
up Health.ES
Spain
Group
new Use Cases
Personal Health Solutions 
new Use Cases
‫ﺣ‬ PHD Working Group
◦ Personal Health Device Working Group (PHDWG) focus on standards that address
transport-independent application and information profiles between Personal Healthtransport independent application and information profiles between Personal Health
Devices (PHDs) and monitors/managers (e.g. health appliance, set top box, cell
phone, personal computer). Existing ISO/IEEE 11073 (X73) standards shall be
evaluated and then used, modified, or new standards defined as needed. In thisevaluated and then used, modified, or new standards defined as needed. In this
context PHDs can be described as devices used for: life activity, wellness monitoring,
and/or health monitoring in domestic home, communal home, and/or mobile
applications. Application and information profiles consist of exchange format, datapp pp p g ,
representation, and terminology for such PHDs.
◦ Anticipated work products include: 1) a technical report describing PHD data, 2) a
common, transport independent application profile for information exchange between
PHDs and monitors/managers, and 3) device specialization standards.
◦ PHDWG is composed by previous participant members of X73 first version (X73-PoC),
and members of universities, manufacturers, providers, and organizations: almost 100
d d l b ( h )individual members (55% North America, 25% Far East y 20% Europe).
◦ The work plan includes: weekly conference calls (alternate between 9 am and 3 pm on
Thursdays/Pacific Time), voting rights (depend on attendance), and
F t F ti ( l d 2 3 th )Face-to-Face meetings (planned every 2 – 3 months).

5. x73
up Health.ES
Spain
Group
new Use Cases
Personal Health Solutions 
new Use Cases
‫ﺣ‬ IEEE11073-00013. Use Cases [Draft Guide for Health Informatics]
◦ Ambient Assisted Living (AAL) [www.aal169.org]
◦ Health & Wellness / Healthy LivingHealth & Wellness / Healthy Living
◦ Strength fitness and cardiovascular fitness
◦ Physical Activity Daily Living Monitoring
◦ Imminent disease control and managementImminent disease control and management
◦ Elderly patient care, independent living activity
◦ Chronic patient follow-up, diabetes
◦ Home monitoring of single cardiac patientg g p
‫ﺣ‬ IEEE11073-104xx. MD Specifications … under development
◦ [-10404] Pulse-oximeter ◦ breathing rate
◦ [ 10406] Heart rate monitor ◦ spirometer◦ [-10406] Heart rate monitor ◦ spirometer
◦ [-10407] Blood pressure monitor ◦ basic ECG (3-leads)
◦ [-10408] Thermometer ◦ peak flow meter
◦ [-10415] Weighing scale ◦ INR-blood coagulation[ 10415] Weighing scale INR blood coagulation
◦ [-10417] Glucose meter ◦ physical activities of daily living monitoring
◦ [-10441] Cardio fitness/activity monitor ◦ CO2 meter, insulin pump
◦ [-10442] Strength fitness equipment ◦ fetal monitor[ 10442] Strength fitness equipment fetal monitor
◦ [-10471] Independent living activity hub ◦ body composition analyzer
◦ [-10472] Medication monitor ◦ simple EEG (1-lead)

6. x73
up Health.ES
Spain
Group
new Use Cases
Personal Health Solutions 
new Use Cases
Near term inverse ranking (100 = most desired) Inverted average short term w/ blanks weighted
(100 t d i d)
‫ﺣ‬ IEEE11073-104xx. New MDs [X73PHDWG voting results]
w ith blanks w eighted.
35
40
(100 = m ost desired)
25
30
15
20
5
10
0
hingrate
irometer
(3-lead)
owmeter
gulant
ent(e.g.
ofdaily
,waking
(1-lead)
O2meter
npump
monitor
mposition
ywater,
(1-lead)
(6-lead)
12-lead)
monitor
orie
r/monitor
G
graphy),
tor/pain
ng
ysensor
naires
ncluding
/APAP/
/VPAP
sensors
sodium/
um
monoxide
son)
ssisted
ldialysis
(2-lead)
(4-lead)
(8-lead)
d,10-20
m)
d,10-10
m)
monitor
covered
hoscope
Breath
Sp
EKG/ECG(
Peakflo
Anticoag
manageme
Activitieso
living(sleep
EKG/ECG(
CO
Insuli
Fetal
Bodycom
(totalbod
EEG(
EKG/ECG(
EKG/ECG(
Cholesterol
Calo
calculator
EMG
(Electromyo
Painmonit
ratin
Sleepquality
Question
(Notethatin
CPAP/
BiPAP
Bloodflow
Bloodsaltss
potassi
Carbonm
(pers
Cycler-a
peritoneal
EEG(
EEG(
EEG(
EEG(21-lea
system
EEG(74-lea
system
Hemoglobin
(Hb/A1Cisc
Steth

7. x73
up Health.ES
Spain
Group
need of interoperability
Interoperability and standardization 
need of interoperability
‫ﺣ‬ p-Health solution requirements
◦ Scalability Devices that can be (directly) added integrated updated◦ Scalability. Devices that can be (directly) added, integrated, updated,
substituted or eliminated of the health solution without changes.
◦ Plug&Play. Automatic connection without technical knowledge,
even multiple connection/disconnection possibility without failures
(Hot&Swap).
◦ Universality: Possibility of select and mix medical components of◦ Universality: Possibility of select and mix medical components of
different manufactures/providers/trademark according to: technical
performance, solution integration requirements, cost, quality level,
personal user preferences/service environment etcpersonal user preferences/service environment, etc.
◦ Integration/usability. Homogenization of different connection
interfaces, access technologies, operatives systems, intercommunication
devices, etc.
◦ Cost reduction. Low work time, high efficiency, high reuse of solution,
low obsolescence risk changes adaptation displacement decreaselow obsolescence risk, changes adaptation, displacement decrease,
low human intervention.

8. x73
up Health.ES
Spain
Group
standard based design
Interoperability and standardization 
standard-based design
‫ﺣ‬ Interoperable solutions  Standardization
◦ Interoperability of medical devices (user/patient)  ISO/IEEE11073
◦ Interoperability of EHR exchange (health centre)  EN13606Interoperability of EHR exchange (health centre)  EN13606
◦ Interoperability of connection interface  RS232/IrDA/USB/Bluetooth/ZigBee
◦ Interoperability of end-to-end technologies  XML/Web Services (SOAP)
Electronic
Healthcare
Record
EHR
e-Health
ISO/IEEE
EHRserver server
RS-232
IrDA
Web
Services
ISO/IEEE
11073
EN13606
health
centre
user/
patient

9. x73
up Health.ES
Spain
Group
X73PHD applications over p Health
Standard-based solutions 
X73PHD-applications over p-Health
Ambient Assisted
Living (AAL)
interoperability
&standardization
g ( )
indepent living activity,
elderly patient care,
chronic patient
&standardization
Inter. organizations
(HL7, ISO/IEEE and
Europe CEN/TC251)
follow-up (diabetes,
VIH), or home
monitoring of single
Europe CEN/TC251),
and new integration
initiatives (IHE,
and Continua
cardiac patient.
and Continua
Health Alliance)
Intensive Care
health&wellness
fitness applications,
auto-control &
h l h
Intensive Care
Units (ICUs)
Classic UCs initially
based on fixed PHDs
management health,
or physical activity
daily living monitoring
th di
based on fixed PHDs
and focused on ICU:
monitoring, pre- and
post-surgery and
are the new paradigm
of p-Health solutions.
p g y
bedside disease
management.

10. x73
up Health.ES
Spain
Group
Intensive Care Units ICU
Standard-based solutions 
Intensive Care Units . ICU
‫ﺣ‬ ICU represents a main example of local patient monitoring with a data report to a CE.
‫ﺣ‬ For each patient a full monitoring equipment is set and the data coming from all patients
are observed from the CE Within every patient’s box several PHDs can be found: multiare observed from the CE. Within every patient s box, several PHDs can be found: multi-
parameter monitor, infusion pump, ECG, pulseoximeter, heart rate monitor, capnography.
‫ﺣ‬ PHDs output has to be converted into the proprietary protocol and sent to the central
system which collects all the signals and alerts and show the overall status To solve itsystem, which collects all the signals and alerts and show the overall status. To solve it,
a X73PHD-solution guarantees the overall compatibility. It allows incorporating any PHD
(independently of their specific requirements) and replacing in failure/update situations.

11. x73
up Health.ES
Spain
Group
Ambient Assisted Living AAL
Standard-based solutions 
Ambient Assisted Living. AAL
‫ﺣ‬ AAL implies health self-control: a user
measures vital signs and sends data
values remotely An X73PHD-basedvalues remotely. An X73PHD based
solution (INtelligent HOLter HOLTIN)
has been developed for heart failure
patient’s follow-up.patient s follow up.
‫ﺣ‬ It is based on wearable PHDs with
ultra-low power consumption and a
wireless monitoring service to controlg
ECG signal during long periods (days
or weeks) in users with non-risk
cardiac pathologies (whose symp-
toms are syncopes and paroxistic
arrhythmias.
‫ﺣ‬ HOLTIN is non invasive, low cost,
d d l h hreduced complexity, high autonomy.
It is made up of several devices in a
BAN/PAN topology that use wireless
t h (Bl t th GPRS UMTS) ttechns (Bluetooth, GPRS UMTS) to
perform a transmission of ECG
information from patient to hospital.

12. x73
up Health.ES
Spain
Group
Ambient Assisted Living AAL
Standard-based solutions 
‫ﺣ‬ Intensa Project
X73PHD manager SW Platform EHR InteroperabilityX73PHD agent
Ambient Assisted Living. AAL
SpO2
HOLTIN
GPRS/3G
X73PHD‐manager SW Platform ‐ EHR Interoperability
Accessibility
Management
System
X73PHD‐agent
glucometer
GPRS/3G
HL7 13606
ADSLHUB
Physician
Weigh
SAPSMS
HL7‐13606
Patient
/LAN
HTA Temperature
g
Scale OracleHP
EHR Family
/

13. x73
up Health.ES
Spain
Group
health & wellness
Standard-based solutions 
health & wellness
‫ﺣ‬ X73PHD-demo testbed. As proof-of-concept, it implements the checking process for
the intercommunication between a CE/manager and several PHDs/agents: blood pressure
device weighting scale and pulse oximeter) to obtain the required vital signs: blooddevice, weighting scale, and pulse-oximeter) to obtain the required vital signs: blood
pressure (systolic/diastolic) and heart rate, weight and height, haemoglobin level, and
even plestimographic curve in a integrated environment.
MD/agent [blood pressure] CE/manager
MD/agent [weighing scale]MD/agent [weighing scale]
MD/agent [pulse‐oximeter]

14. x73
up Health.ES
Spain
Group
open points next challenges
Further researches 
open points. next challenges
[tester/audit] Design/implementation of X73PHD testbed environment.
X73PHD-libraries/packets/frames generation for technical audit.
[f k] Mi ti t th f k/ ti t ( d id bi )[framework] Migration to other framework/operative systems (android, symbian).
Integration of multiple PHDs over configurable CE (Config Profile).
[controllers] Migration to controllers implementation.
Design/implementation of patterns for frames/PDUs generationDesign/implementation of patterns for frames/PDUs generation.
[harmonization] X73PHD vs SCP-ECG integration for ECG devices (S&F y RT).
X73PHD/EN13606 vs HL7 integration (IHE/Continua).
ISO/IEEE
11073
EN13606
SCP-ECGSCP ECG