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This book provides a multidisciplinary overview of the design and implementation of systems for remote patient monitoring and healthcare. Readers are guided step-by-step through the components of such a system and shown how they could be integrated in a coherent framework for deployment in practice. The authors explain planning from subsystem design to complete integration and deployment, given particular application constraints. Readers will benefit from descriptions of the clinical requirements underpinning the entire application scenario, physiological parameter sensing techniques, information processing approaches and overall, application dependent system integration. Each chapter ends with a discussion of practical design challenges and two case studies are included to provide practical examples and design methods for two remote healthcare systems with different needs.



Chapter 1. A Clinician’s View of Next-Generation Remote Healthcare System

There are few critical questions to answer in relation to remote healthcare systems and the pertinent technologies implied in transferring surveillance and care next to the patients: (1) will they help reducing and/or at least rationalizing care and lower hospitalizations and connected high costs?; (2) will this be really at hand in the near future?; and (3) what are the relevant parameters to obtain and follow in order to make remote healthcare an impacting reality on health systems? “There will be titanic changes ahead—Medicine can and will be rebooted and reinvented one individual at a time”: cultural, technological and scientific features will have a stronger relevance and impact on orienting the future revolution and decision than administrative and merely technological processes. However, the future remote healthcare model should be based not only on Darwin’s selection of a more and more powerful market (hundreds of billions in Europe), or cumbersome, restrictive, national (or even local) rules. It should start from strong ethical and scientific bases. The great potential benefits should be addressed on humans and on processes of care. Continuity of care, prevention and healthcare throughout the person’s life are an excellent beginning. The future will not depend on our technological capacities but on our decision-making capacity of creating systems based on a global approach, in order to cope with the complexity of healthcare environment. Remote healthcare should involve physicians, patients, academics, health service organizations and industries, integrating all their different points of views, not neglecting the final user’s needs. Use case scenarios are reviewed here, from pre- to post-hospitalization and from the management of congestive heart failure to chronic obstructive pulmonary disease, hypertension and diabetes and renal diseases. It seems that future remote health system should provide the parameters to evaluate trends and short-term predictive indexes and may thus help paving the road for a great revolution in Medicine, based on decision-logic module that computes in an automated way the potential risk of an impending episode by information fusion of heterogeneous sensor, demographic data and evidence-based clinical diagnosis process.
Paolo Emilio Puddu, Alessandra D’Ambrosi, Paola Scarparo, Emilio Centaro, Concetta Torromeo, Michele Schiariti, Francesco Fedele, Gian Franco Gensini

Chapter 2. System Overview of Next-Generation Remote Healthcare

Pervasive communication technologies and tiny wireless monitoring devices have provided a solid foundation for the idea of remote healthcare. This idea aims at making available over communication networks (e.g. the Internet) some of the fundamental healthcare services commonly available only in conventional medical facilities and clinical settings. Information and communication systems supporting ubiquitous and continuous remote healthcare provision have been effectively employed in a number of application scenarios. In this chapter we mainly focus on patient monitoring activities as they are general enough to demonstrate most of the technical and procedural challenges that need to be addressed in remote healthcare systems. The main contributions of the chapter are a detailed definition of necessary functional and non-functional requirements for such systems and the identification, design and discussion of a reference architecture conceived to properly meet these requirements.
Andrea Vitaletti, Stefano Puglia

Chapter 3. Vital Sign Sensing Technology

The four physiological measures of body temperature, pulse rate, respiration rate and blood pressure have for a long time been considered as vital signs in the diagnosis of a patient’s health. It is also widely accepted that the routine measurement of other physiological or biological signals, possibly pathology specific, would help considerably in diagnosis and early stage treatment. Such measurements might include, for example, heart activity, brain activity, blood glucose level or mobility. Furthermore, the development of portable systems that can make a number of different health related measurements would prove beneficial in the monitoring of patients during treatment, recovery or rehabilitation. Technologies and instruments that can make these measurements have existed for some time, but factors such as their cost, lack of portability and in some instances, a requirement for expert knowledge, have restricted their wide scale use. Today, however, advances in information technology, communications and microfabrication techniques have made possible the realisation of truly portable systems for the measurement of a wide range of physiological signs at any medical intervention. This chapter describes the sensing technologies and systems currently being developed, or that are in use, for the measurement of a new, larger range of vital signs.
Andy Cranny, Andoni Beriain, Hector Solar, Gennaro Tartarisco, Giovanni Pioggia

Chapter 4. Signal Processing Architecture Implementation Methodologies for Next-Generation Remote Healthcare Systems

Remote healthcare, an emerging application with limited resources, requires sophisticated signal processing algorithms and their efficient architectural implementation methodologies. Direct mapping of traditional signal processing algorithms to hardware may not be suitable for such resource constrained applications. It is therefore necessary to explore the signal processing algorithms used for this applications and their corresponding low complexity and low power consumption architectural implementation using an algorithm-architecture holistic optimization approach. This chapter identifies and does the review on the traditional computationally intensive signal processing algorithms which are of significant use for healthcare related applications, focuses on the corresponding low-complexity architecture design and formulates the model of computing the overall hardware complexity of these architectures.
Amit Acharyya

Chapter 5. Machine Learning Techniques for Remote Healthcare

In this chapter, popular machine learning techniques are discussed in the context of remote healthcare. In this domain the main challenges are low computational complexity and hardware implementation, and not just conventional way of mathematical analysis of machine learning algorithms. Statistical view-point of different machine learning techniques, standard parametric and nonparametric algorithms for classification and clustering are briefly discussed. A practical 12-lead Electrocardiogram (ECG) signal based myocardial scar classification example has also been shown as a representative example. Complexity of few classification algorithms, online implementation issues for statistical feature extraction and some open research problems have also been introduced briefly.
Saptarshi Das, Koushik Maharatna

Chapter 6. Patient Health Record (PHR) System

This chapter focusses on the introduction of the Electronic (EHR) and Personal Health Records (PHR) as new technological approaches aimed at standardising electronic management of medical information between the patient and its physicians, as well as among medical organisations collaborating in providing integrated medical care services. We start with the introduction of the roles and aims behind EHR, followed by the description of the applicable legal and standardisations frameworks and European activities in this area, finishing with the introduction to most common commercial as well as open-source implementations of such systems. As a conclusion we also signal ethical and privacy concerns that are relevant to using and exchanging electronic health information.
Artur Krukowski, Carlos Cavero Barca, Emmanouela Vogiatzaki, Juan Mario Rodríguez

Chapter 7. Wireless Sensor Networks: A Key Enabling Technology for Remote Healthcare

Recent advances in ICT and sensing technologies have created exciting options for individualised sensing and health monitoring. Wireless Sensor Networks (WSN) that are built of lightweight and autonomous devices called sensor nodes are a concrete example of such technologies. Each sensor node typically combines individual sensing, processing and wireless communication features into one small device. This chapter motivates the use of WSN as a key enabler for remote health care by introducing the manifold facilities and use cases of that technology. Based on that, it discusses the architectural basics and provides insights into practical system design issues, especially in view of reliability, energy efficiency and security of the system. After that an assessment of design goals and most critical challenges for applying WSN in health care is given. The chapter finally closes with presenting several selected solutions that successfully tackle introduced challenges.
Steffen Ortmann, Peter Langendoerfer, Marcin Brzozowski, Krzysztof Piotrowski

Chapter 8. System Integration Issues for Next-Generation Remote Healthcare System

The system integration is always a terrible headache for IT technologists. Several aspects are related to a proper integration of different components and services into remote healthcare solution. Furthermore the overall integration issue cannot be regarded only from a technical point of view but it has to take into account aspects such as deployment scenario, service organization, educational and business context, resource sharing with other services. The system integration is a crucial activity and requires to be properly planned, it is based on system and service architecture design however it must be empowered taking into account use case and deployment scenario, functional and technical specification and interoperability requirements with other services. Due to the variety and complexity of system integration, in this chapter only some of the major issues related to system integration are taken into account; in particular the authors have selected the following main issues: system integration topics checklist; the interoperability and portability of data as one of the crucial aspects enabling system integration and proper deployment of solutions into the healthcare domain; structured approach for solution deployment; the user interface design as basic aspect to engage the medical professionals. Finally the critical issues are raised breaking down the lessons learnt.
Cristiano Paggetti, Carlos Cavero Barca, Juan Mario Rodríguez

Chapter 9. A Business Perspective

Major trends are impacting healthcare such as the access to a larger number of people, the growing demand for better quality of care, the ageing of the population in Europe; all of them are causing skyrocketing healthcare costs. To cope with these challenges improvements in quality and efficiency are needed and new organizational models with major changes in the way healthcare services are organized and delivered to the citizens have to be introduced.
Healthcare has to move from treatment to prevention, from a “clinical-centric” to a “patient-centric” approach where the citizen is motivated and empowered to manage his own health.
ICT will play an important role in this new scenario and this healthcare’s evolution is attracting the attention of the industry. The digital revolution is impacting healthcare too. The new frontier of the mobile healthcare (m-health) will contribute to bridge the gap between the healthcare system and the citizens and will increase the level of patient/caregiver connectivity.
From a business perspective e-health represents a market still in a nascent phase with a lot of barriers and challenges but has the potential of becoming the third largest industry in the healthcare sector. Mainly in this initial phase, small and medium enterprises, technology-driven companies, innovators could have great opportunities.
This chapter deals with the specificity of the e-health business; it identifies business opportunities, investigates on the existing barriers and analyses possible business models and the methodologies for a socio-economic assessment of e-health.
Silvio Bonfiglio

Chapter 10. Case Studies

Information and Communication Technologies—as analyzed in this book—could allow a radical change in the way healthcare services are delivered to the citizens and could represent an effective tool to cope with the today’s healthcare challenges.
In this chapter we introduce two European research projects where large part of the concepts addressed in this book are applied; they are the MICHELANGELO project of the seventh Framework Program and CHIRON of the ARTEMIS JU Program.
The CHIRON project (Cyclic and person-centric health management: Integrated approach for home, mobile and clinical environments) focuses on prevention i.e. on a move away from ‘health care’ towards ‘health management’, from ‘how to treat patients’ to ‘how to keep people healthy’, from a “reactive care” to a “proactive care”. CHIRON designed a system’s architecture making possible a “continuum of care” i.e. an integrated health management approach in which health is patient-centric at home, in the hospital and in nomadic environments. Care is moved from the hospital to the home and the healthcare staff is enlarged by adding informal carers to the medical professionals and by motivating and empowering the patient himself to manage his own health. Moreover the CHIRON system builds a personalized risk assessment of the patient by integrating personal information, data gathered at home and in a mobile environment through an innovative set of wearable sensors and data available at the hospital including outcomes of image-based tests. The expected results are a reduction of the healthcare costs and a better quality of care.
MICHELANGELO addresses a specific category of patients i.e. the autistic children; the aim is to use ICT to promote and facilitate the assessment of autism within the home setting, away from the traditional clinical environments and to provide personalized “home-based” intervention strategies. This is achieved through the provision of cost-effective, patient-centric home-based intervention remotely controlled by the therapist (remote rehabilitation). The proposed method aims at enhancing the effectiveness of the treatment through its “intensiveness” and “personalization” matching the individual characteristics of autistic children and the involvement of the parents in their “natural” home environment in the role of “co-therapists”.
Both projects offer interesting inputs on how Information and Communication Technology could help in “revolutionizing” healthcare. It is worthwhile to highlight that both projects keep the doctors at the core of the healthcare process and in both of them technology is not replacing the experience and the competences of the medical professionals and is not removing the needed physical contact between them and the patients but it supports the doctors in executing their tasks in a more effective and better way.
This chapter is split into two parts: in the first we will introduce the two projects mainly from a strategic perspective in line with the current efforts towards “radical changes” needed to cope with the heavy challenges the healthcare system is facing.
The second part gives a technological insight of the CHIRON project and shows how this project is deploying several of the concepts analyzed in the previous chapters of this book.
This part presents the architecture of an integrated continuous monitoring system for Cardiovascular Disease (CVD) patients in nomadic settings developed under the ARTEMIS-JU CHIRON Project. The proposed sensor platform constitutes of commercially available subsystems effectively integrated into a single multi-sensor non-invasive wearable solution. To enable medical experts to assess the patient’s condition remotely, a number of analysis algorithm were developed and implemented into an Android application in order to provide the desired medical information. The key challenge in the development of these algorithmic solutions, was to balance the expected performance while maintaining a low level of power consumption, thus facilitating the continuous monitoring purpose of the system. Furthermore, a web-server based framework provides medical experts with an interactive analysis and monitoring interface and provides the infrastructure for storing the obtained data.
Evangelos B. Mazomenos, Juan Mario Rodríguez, Carlos Cavero Barca, Gennaro Tartarisco, Giovanni Pioggia, Božidara Cvetković, Simon Kozina, Hristijan Gjoreski, Mitja Lustrek, Hector Solar, Domen Marincic, Jure Lampe, Silvio Bonfiglio, Koushik Maharatna
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