The Future of Personal Health: Requirements, Technology, Applications, Standards
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1 The Future of Personal Health: Requirements, Technology, Applications, Standards Orlando, 13 May 2011 Bernd Blobel ehealth Competence Center University Hospital Regensburg 12th International HL7 Conference, Lake Buena Vista, Florida Thomas Norgall Fraunhofer Alliance Ambient Assisted Living c/o Fraunhofer Institute Integrated Circuits IIS 1
2 Person-Centered Care (phealth) HCE1 HCE2 HCEn HCEn+1 HCEp HCEz S1,1 S2,1 Sn,1 Sn+1,1 Sp,1 Sz,1 S1,2 Sn,2 Sn+1,2 Sz,2 Sn,3 EHR Sz,3 Personal Health Record
3 e-health Interaction and Integration Paths E H R General Practitioner ECG Ultrasound E-prescription E-Letter E- Consultation... Specialist Electronic Health Record Hospital H I S HL7 Phar macy... Monitor IC U Manager IHE Intensive Care Units... Pump Agent PDMS Respi rator Agent... DICOM R I S Radiology L I S P o C CT MR X-Ray Analyser Analyser P o C Lab... Pharmacies Insurance Companies Labs, Care services etc.
4 Mobile Computing Accessability Tele-Consultation
5 e-health Interaction and Integration Paths E H R General Practitioner ECG Ultrasound E-prescription E-Letter E- Consultation... Specialist Electronic Health Record Hospital H I S HL7 Phar macy... Monitor IC U Manager IHE Intensive Care Units... Pump Agent PDMS Respi rator Agent... DICOM R I S Radiology L I S P o C CT MR X-Ray Analyser Analyser P o C Lab... Pharmacies Insurance Companies Labs, Care services etc.? Home / mobile
6 Pervasive Computing Location-independent Service Delivery Telematics, Telemedicine Mobile Computing Accessability Tele-Consultation
7 Pervasive Computing Location-independent Service Delivery Telematics, Telemedicine Ubiquitous Computing Autonomous Computing Self-organization Health Information Systems Mobile Computing Accessability Tele-Consultation
8 What is Personal Health? Orlando, 13 May 2011 Personal Health Systems include portable medical devices or systems specifically designed for diagnostic and therapy-supporting (long-term) monitoring application in home or mobile environments. Personal Health identifies increasing individual / private customer availability of medical equipment, information and services that were traditionally only accessible for health care professionals / professional institutions (- similar to the establishment of Personal Computers complementing professional computing equipment). Technology is enabler and driving force Personal Health also characterizes the transition from traditional organization-centric health organization of health services to person-centric individualized services / personal responsibility for prevention, diagnostics, therapy and care (ehealth / phealth) 8
9 Technology as Enabler for Personal Health Systems Components get smaller and cheaper, need less power Active Transponder Orlando, 13 May 2011 Wireless Sensor Module Fraunhofer IZM 9
10 Technology as Enabler for Personal Health Systems Mobile computers, intuitive UI, wireless communication Orlando, 13 May 2011 : Motorola 10
11 Soon: Integration of Electronics into Smart Textiles Crimping Orlando, 13 May 2011 Embroidering Laser Welding/Soldering Fraunhofer IZM 11
12 Soon: Intelligent Clothes as Monitoring Platform Orlando, 13 May 2011 ECG Respiration and Activity Activity/Movement 12
13 Future: Smart Implants (Micro-Electronics / -Mechatronics) Functional eye prothesis Moving eye with integrated camera (Collaborative approach: Fraunhofer IZM / Moran Eye Center / Huntsman Cancer Institute) E. Fernandez, Univ. Alicante EC funded Cortivis Project A: outer shell B: cosmetic insert, depitcted with lens C: Actuation mechanism, depicted with electrostatic plates Orlando, 13 May 2011 E: Wireless Camera Unit D: Control Electronics F: Energy Supply i) converter ii) rechargeable battery iii) inductive power link 13
14 But how can we make all these devices collaborate? Orlando, 13 May
15 STMicroelectronics and Mobidiag Unveil Labon-Chip for Rapid Bacterial Diagnosis
16 Pharmaceutical Companies Start to Provide Pills with Embedded Microchips (Mike Adams, Reuters Communication, ) Within its Smart Pills Initiative, Novartis AG, one of the biggest pharmaceutical companies worldwide, announced to implement the chip-in-a-pill technology developed by privately owned Proteus Biomedical of Redwood City, California in its products. The biotech start-up's ingestible chips are activated by stomach acid and send information to a small patch worn on the patient's skin, which can transmit data to a smartphone or send it over the Internet to a doctor. Novartis aggreed to spend $24 million to secure acces to personal medical information provided by the chip. In the future, the use of the technology is also planned to collect information about heart rate, body temperature, body movement as well as to check that drugs are working properly.
17 Talking Organs: Talking Hand Phenotyping of persons ehealth card epatient record Person monitoring Attention Concentration Coordination Reactivity Symptom assessment of neuromotor dysfunctions caused by diseases e.g. Parkinson Multiple Sclerosis Infarction Stroke Symptom assessment and therapy in psychology and education e.g. ADHD Patient monitoring and medication control (remote and mobile) Telemedicine Homecare Clinical trials: testing drug administration and dosage Monitoring of humans on drugs or under physical or mental stress
18 Talking Organs: Talking Eye Retinal microangiopathy Retinal bleedings Micro-infarction of the retina Diabetic alteration Swelling of the optical nerve Atrophy of the optical nerve Glaucoma Prevention and therapy
19 Promises of Bioinformatics to Health Sciences (After Brendan McConkey) Genetic profiling Identification of genetic predispositions Prognosis and treatment Prediction of response to treatment Tailoring treatment to tissue subtype Diagnostics early detection of disease Serum protein biomarkers Identification of novel drug targets Application to multi-factor diseases
20 (After SIEMENS)
21 Interoperability Challenge: Which of these common standards are relevant for your Personal Health system? Cabled Networks: Ethernet (32 variants!), HomePlug, HomePlugAV Point-to-Point: DisplayPort, DVI, FireWire, HDMI, SCART, USB Field Buses: BACnet, BatiBUS, EHS, KNX/EIB, LON Wireless Networks: WLAN, ZigBee, Z-Wave, EnOcean, Bluetooth, DECT, HomeRF Network Protocols: AFP, BitTorrent, Bonjour/Zeroconf, CalDAV, CUPS, DHCP, DNS, DPWS, DynDNS, FTP, HTTP, IMAP, IPP, IRC, JetDirect, LDAP, LPR, NAT-PMP, NFS, OMA DM, POP3, RTP, RTSP, SIP, SMB, SMTP, SNMP, SSDP, SSH, TFTP, TR-069, UPnP, WebDAV, CHAIN/AIS, SML, Health Application: aecg, CCD, CCR, CDA, CEN/ISO/IEEE 11073, DICOM, EDF, EDIFACT, HL7, IHE, ISO/EN 13606, PHMR, SCP-ECG, xdt, XPHR, ICD-10, ICHI, ICPM, LOINC, OPS, SNOMED, UCUM, UMLS Runtime: OSGi,.NET, Linux, MIDP Middleware: Agent System, SOA, Event Based, URC A real challenge for product designers, developers, integrators OFFIS Institute
22 2011: 250+ Continua members developing Personal Health solutions Orlando, 13 May Continua Health Alliance
23 Supported Domains Disease Management Agent Examples: Pulse oximeter, Heart rate monitor, Blood pressure monitor, Thermometer, Weighing scale, Glucose meter Health and Fitness Agent Examples: Heart rate monitor, Weighing scale, Thermometer, Cardiovascular fitness and activity monitor, Strength fitness equipment Independent Living (Aging Independently) Agent Examples: Disease management devices plus Independent living activity hub, Medication monitor
24 Orlando, 13 May 2011 Continua Health Alliance 24
25 Continua Version One Device Connectivity Standards Orlando, 13 May 2011 Pulse Oximeter Pulse /Bloodpressure Thermometer Weight Scale Glucose Meter Cardiovascular and Strength Fitness Monitor Independent Living Activity Medication Monitor ISO/IEEE = Base Protocol ISO/IEEE = Pulse Oximeter ISO/IEEE = Pulse / Heart Rate ISO/IEEE = Blood Pressure ISO/IEEE = Thermometer ISO/IEEE = Weighing Scale ISO/IEEE = Glucose Personal Health System ISO/IEEE = Cardiovascular Fitness Monitor ISO/IEEE = Strength Fitness Equipment ISO/IEEE = Independent Living Activity ISO/IEEE = Medication Monitor Bluetooth Medical Device Profile Specification USB Personal Healthcare Device Class Specification Cell Phone PC Set Top Box Aggregator Continua Health Alliance 2 5
26 Why were ISO/IEEE standards & group selected for (Continua) Personal Health standardization? Respected standards body with open participation Harmonized with ISO for International Standards Also harmonized with NCCLS/CLSI, HL7, CEN TC251, ISO TC215, IHE, FDA, and NIST ISO/IEEE already formed and active ISO/IEEE Charter contains health care devices Standards structured to be transport portable Able to support Disease Management, Health and Fitness, and Independent Living Low cost for membership and access to standards CONTINUA Health Alliance
27 CEN/ISO/IEEE HL7 Devices SIG / ISO/IEEE HL IHE PCD Domain Domain from Clinical to Personal Health devices and applications Orlando, 13 May
28 Personal Health Data Standards Work Technical Report - Overview Pulse Oximeter Blood Pressure Device Specializations Glucose Pulse Weighing Scale Thermometer Common Framework Phase II Optimized Exchange Protocol Serial IrDA Bluetooth USB ZigBee OSI Layers 1-4 Layer 5-7
29 IEEE Modeling ASN.1 Domain Information Model Nomenclature Service Model Communication Model ASN.1 language used in the abstract modeling of data and interactions Domain Information Model (DIM) describes the device and physiological data Nomenclature provides binary codes for terminology Service Model defines interactions with the device and data Communication Model manages the connection state machine and communication characteristics
30 Personal Health & Ambient Intelligence / AAL Research: How can future devices disperse into smart environments? AAL = Ambient Assisted Living, an application domain of Ambient Intelligence Smart assistive environments that are sensitive and responsive to the presence, behavior, physical and mental state of people. Components / devices cooperate to support / assist healthy, handicapped and diseased people in carrying out their everyday life activities using information and intelligence in the network connecting these components / devices. As components / devices get smaller, more connected and more integrated into environments, technology virtually disappears until only the user interface remains perceivable by users. Orlando, 13 May >Future Ambient Assisted Living (AAL) also includes Personal Health aspects and applications 30
31 Summary: Requirements and Services in ehealth/phealth/ mhealth Confidentiality Integrity Availability Identification Authentication Autorization Non-Repudiation Privacy Usability Reliability Simplicity Auditability Transparency Robustness Handiness Efficiency Efficacy Scalability Self-Adaptation Range Power Comsumption Reduction of Weight and Size
32 Thank you for your attention! Thomas Norgall Deputy Spokesman Fraunhofer Alliance Ambient Assisted Living c/o Fraunhofer Institute Integrated Circuits IIS / BMT Am Wolfsmantel 33 D Erlangen nor@iis.fraunhofer.de Orlando, 13 May 2011 Bernd Blobel PhD, FACMI, FACHI, FHL7, Head, Associate Professor Chair HL7 Germany Chair CEN/ISSS ehealth Standardization Focus Group Chair IMIA Working Group Standards in Health Care Informatics Chair EFMI Working Groups EHR and Security, Safety and Ethics Chair of the German Health Informatics Standards Committee Head of the German Delegation to ISO and CEN ehealth Competence Center University Hospital Regensburg Franz-Josef-Strauss-Allee 11 D Regensburg bernd.blobel@klinik.uni-regensburg.de 32
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