4/10/2011
Roadmap Part I: General Intro
e-Health Services: Potential, Challenges, & Way Forward
• • • • •
What’s telemedicine? Why do we need it? Funding Telemedicine applications and their requirements Readily deployed systems
Part II: Wireless/Mobile Tele-Medicine • Supporting technologies • WMAN, WLAN, WPAN, BANs • Open Issues
Tarik TALEB NEC Europe Ltd, Germany Tohoku University, Japan
Part III: Eldercare Services • Ubiquitous Assistance vs Ubiquitous Networking • ANGELAH framework
E-Health and Telemedicine in Quotes
General Introduction
• ―E-health is an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies. In a broader sense, the term characterizes not only a technical development, but also a state-of-mind, a way of thinking, an attitude, and a commitment for networked, global thinking, to improve health care locally, regionally, and worldwide by using information and communication technology.‖ — Gunther Eysenbach, J Med Internet Res 2001;3(2):e20 (2001) • ―Telemedicine is the use of electronic communication and information technologies to provide health care when distance separates the medical professional from the patient. It also includes educational and administrative uses of these technologies in support of health care, such as distance learning and administrative videoconferencing.‖ — Association of Telehealth Service Providers (2000)
Why Telemedicine & E-HealthCare?
Demographic Compression
• Evolution to Super-Aged society:
▫ Rapid growth of aging population in developed countries
• Increasing health cost:
▫ Wide medical expenditure is quite huge ▫ Welfare systems under stress
• The structure of diseases is changing ▫ Lifestyle related diseases
• Increasing social cost:
▫ Lack of undependability in performing basic daily activities
• Medical institutions’ difficulties
▫ Many hospitals run in the red ▫ Shortage of doctors, too much burden to doctors ▫ Clerical work is still inefficient
Source: pictures of the future: the greying society 2005, Siemens
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Why Telemedicine & E-HealthCare? • Evolution to Super-Aged society:
Healthcare Spending as % GDP
▫ Rapid growth of aging population in developed countries
• Increasing health cost:
▫ Wide medical expenditure is quite huge ▫ Welfare systems under stress
• The structure of diseases is changing ▫ Lifestyle related diseases
• Increasing social cost:
▫ Lack of undependability in performing basic daily activities
• Medical institutions’ difficulties
▫ Many hospitals run in the red ▫ Shortage of doctors, too much burden to doctors ▫ Clerical work is still inefficient
Why Telemedicine & E-HealthCare? • Evolution to Super-Aged society:
▫ Rapid growth of aging population in developed countries
• Increasing health cost:
▫ Wide medical expenditure is quite huge ▫ Welfare systems under stress
• The structure of diseases is changing ▫ Lifestyle related diseases
• Increasing social cost:
Why Telemedicine & E-HealthCare? • Increase access to continuing medical education and training • Reduce professional isolation among doctors and other health care staff located remote and rural areas • Provide an advanced medical services in emergencies
▫ Lack of undependability in performing basic daily activities
• Medical institutions’ difficulties
▫ Many hospitals run in the red ▫ Shortage of doctors, too much burden to doctors ▫ Clerical work is still inefficient
Why Telemedicine & E-HealthCare? • Organization of epidemiological surveillance groups • Creation of specialized Regional and National databases • Multi-country training in public health
PC-based Interactive Digitally Enhanced VR/Multimedia Mannequins
Virtual Workbenches
Overall Objectives Reduce Healthcare Cost & Enhance QoL
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Opportunities
Goals of Telemedicine & E-Health
• Today’s Wireless Medical Devices ▫ Cheaper, smaller and more reliable ▫ More robust radio systems enabled by low cost microprocessor intelligence ▫ Reduced interference in protected medical frequency bands ▫ Lower costs through global standardization
• To provide consultation and interpretation in regions of demonstrated need • To provide specialist services in hospitals without on site support
• Wireless communications are rapidly expanding in developing countries
• To enhance the Quality of Life of individuals
▫ Increased awareness, interest & acceptance of wireless
• To promote educational opportunities for physicians
• Internet II may provide sufficient bandwidth for telemedicine
Opportunities
Smart Phones Racing Ahead of NWs
• Today’s Wireless Medical Devices ▫ Cheaper, smaller and more reliable ▫ More robust radio systems enabled by low cost microprocessor intelligence ▫ Reduced interference in protected medical frequency bands ▫ Lower costs through global standardization
• Wireless communications are rapidly expanding in developing countries ▫ Increased awareness, interest & acceptance of wireless Intel
• Internet II may provide sufficient bandwidth for telemedicine
BlackBerry® WebWorks
Samsung
17
3GPP Access: Seeking for Speed UMTS 2 Mbps
1999
HSDPA DL: 14.4 Mbps UP: 384 Kbps
2002
UMTS (W-CDMA)
Rel 99
HSUPA DL: 14.4 Mbps UP: 5.7 Mbps
2004
HSDPA
Rel 5
W-CDMA
Wideband Code Division Multiple Access
EDGE
Enhanced Data rates for Global Evolution
GPRS
General Packet Radio Service
GSM
Global System for Mobile Communicationsm
More Speed
HSPA+ DL: 28 Mbps UP: 11 Mbps
2007
HSUPA
Rel 6
LTE DL: 0.3Gbps UP: 75Mbps
LTEAdvanced DL: 1Gbps UP: 0.5Gbps
2008
HSPA+
Rel 7
2010 LTEAdvanced
LTE
Rel 8
SAE
Rel 10
Rel9 LTE
Long Term Evolution
HSUPA
High Speed Uplink Packet Access
HSDPA
High Speed Downlink Packet Access
UMTS
Universal Mobile Telecommunications System
Source: Japanese Ministry of Internal Affairs and Communications
19
20
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Opportunities • Today’s Wireless Medical Devices ▫ Cheaper, smaller and more reliable ▫ More robust radio systems enabled by low cost microprocessor intelligence ▫ Reduced interference in protected medical frequency bands ▫ Lower costs through global standardization
• Wireless communications are rapidly expanding in developing countries ▫ Increased awareness, interest & acceptance of wireless
• Internet II may provide sufficient bandwidth for telemedicine
Disadvantages & Pitfalls • Incorrect diagnoses • Need good telecommunication network ▫ Telecommunications limited in many parts of Africa and Asia- satellite shows promise
• Training of staff & physicians • Patient confidentiality ▫ Management of personal data
• Security • Social Anthropology ▫ Ethical and legal ▫ Regulatory compliance
Funding in USA Total Funding $350,000,000 $300,000,000
TELEMEDICINE’s R&D
$250,000,000 $200,000,000 $150,000,000 $100,000,000 $50,000,000
Some On-Going Research Activities • • • • • • • • • • • • • • • • • • • •
Georgetown University Howard University Harvard University Mass Institute of Technology University of Maryland University of Utah Rutgers University Saint Francis University Drexel University Loma Linda University University of Tex-Houston HSC Univ. South Florida University of Hawaii University of Pittsburgh Stanford University Yale University Texas A & M Johns Hopkins Univ. USC University of Oregon
(CA-Medical Vangaurd) (CRDA-Urban Telemed) (CA-CIMIT) (CA-CIMIT) (IPA/CA – ORF) (Contract-Teleopth) (CA-CEMBR) (CRDA-CERMUSA) (CA-CIMERC) (CA-NMTB/Proton Beam) (CA-DREAMS) (CA-Telerad/Adv Cancer Detect) (CA-Telemed Curric’lm) (Contract-GGTS) (Contract-Affiliates Prog) (IPA-Adv Tech Watch) (CA-DREAMS) (CA-Periscopic MIS) (CA-NGI) (CA-BBM)
05
04
FY
03
FY
02
FY
01
FY
00
FY
99
FY
FY
FY
98
$0
USA Department of Defense (DoD) & Federal Research • U.S. Army Research Laboratory • Los Alamos National Laboratory • Sandia National Laboratory
• Distributed, Synchronized Databases • Advanced, Adaptive Multilevel Security • Data Mining of Disparate Databases • Secure Global Positioning System
• U.S. Army, Signal Battle Laboratory
• Network Management Tools
• Commo & Electronic Command
• Info Warfare Surveillance & Defense Tools
• Oak Ridge National Laboratory
• Artificial Intelligence - Expert Systems
• Veterans Administration
• Fault Avoidance and Recovery Systems
• NASA
• Hands Free, Wireless Telecom
• DARPA
• Wireless Networking
• National Library of Medicine (NIH)
• Data Compression
• Agency for Health Research & Quality
• High Bandwidth Datalinks
• Food & Drug Administration • Centers for Disease Control & Prevention
• Low Power Electronics • Multi-platform, Interoperable Software • Complex Modeling and Simulation
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Relevant Japanese Governmental Policies
921 Earth Quake Urged Telemedicine in Taiwan • Sep 21th 1999, 1:47 AM • Measured 7.3 on the Richter scale • 2,415 people died, 29 disappeared, and over 11,000 injured
Other International Activities • • • • • • • •
US/Norway Telemedicine NATO – Telemedicine Standardization Committee Canada: International Space Station, Telesurgery South African Military Health Service Poland: International Global Satellite System Central America, Bosnia, Afghanistan: Landmine Victim Assistance Panama: Yuma Proving Ground - Tele-pathology, Hyper-spectral Imaging Argentina: Civilian Medical Emergency Response
• About 110 thousand buildings collapsed, transportation was almost completely destroyed in the area
IEEE Communications Magazine, Apr. 2006
Standardization Activities
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Health Level Seven (HL7) Protocol • HL7 is a standard for exchanging information between medical applications. • “Level Seven” refers to the the health care environment.
7th
OSI layer protocol for
• HL7 is a protocol for data exchange. It defines the format and content of the messages that applications must use when exchanging data with each other in various circumstances. • Source:
▫ http://www.interfaceware.com/manual/what_is_hl7.html
Laws and Regulations in USA • Health Insurance Portability and Accountability Act ▫ enacted by the U.S. Congress in 1996
• Title I of HIPAA:
▫ protects health insurance coverage for workers and their families when they change or lose their jobs
• Title II of HIPAA: (known as the Administrative Simplification provisions)
▫ requires the establishment of national standards for electronic healthcare transactions and national identifiers for providers, health insurance plans, and employers ▫ also addresses the security and privacy of health data
• Encourages the wide spread use of electronic data interchange in the US health care system
Types of Telemedicine Communications • Store-and-forward communications
Telemedicine Types
Types of Telemedicine Communications • Real time interactive communications
▫ Enable both parties (a physician or medical specialist and a patient) at the same time, but at different locations, to establish a communication link between them ▫ Used for general consultation or remote surgery and require full attention of all party at the same time
▫ Acquire medical data and then transmit the data to a physician or medical specialist at a convenient time for offline assessment ▫ Best use of doctor’s time
Types of Telemedicine Communications • Remote Patient Monitoring ▫ Monitor not critical applications (video streaming, voice streaming)
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Telemedicine Design Guidelines & Requirements • • • • • • • •
Medical Applications & Requirements
Bandwidth Delay Availability Security Ubiquity Power conservation Reliability Heterogeneity
• Life critical applications have QoS requirements much stricter than multimedia, voice applications • A medical web application to access patient record ▫ Similar to any IT Web application ▫ However, more delay-sensitive & loss-sensitive
• Real-time transmission of an alarm/alert ▫ Delay-sensitive & Loss-sensitive
Medical Applications & Requirements Applications
Requirements BW
Delay
Data loss (MAC PER)
Reliability
Ubiquity
Security
Low BW
Low delays
Loss sensitive
High
Not required
Integrity
Real-time critical apps. (e.g., physiological Parameters)
Continuous low BW
Low delays
Very loss sensitive
High
Required
Authentication & confidentiality
Real-time noncritical apps. (e.g., Video, audio)
Low (voice) to high (video) BW
Low to moderate Delays.
Tolerate low data loss
Not critical
Required
Authentication & confidentiality
Office/Medical IT (e.g., Web browsing)
High BW
Delay not sensitive
Loss sensitive
Required but not critical
Pervasive connectivity required
Authentication, integrity & confidentiality
Remote control apps. (e.g., Control/ settings)
Readily deployed telemedicine/e-health services and systems • Mozambique project: ▫ Jan 1998 – First ITU Telemedicine project was implemented in Mozambique, connecting two hospitals (one in Maputo and the second in Beira) for tele-radiology
• Monmouth Medical Center (Long Branch, NJ): ▫ Operation rooms have video/audio connection to the Internet. ▫ Doctors can consult about the surgery in real-time remotely. ▫ Doctors can connect to the entire system from their homes. ▫ http://www.saintbarnabas.com/hospitals/monmouth_med ical/index.html
Readily deployed e-health services & systems
Readily deployed telemedicine/ehealth services and systems • In 2000, EU project ―TeleInVivo‖ performed echography examination by an expert standing next to the patient. ▫ Ultrasound data was sent by satellite to a base station to be processed. ▫ http://www.igd.fhg.de/igda7/projects/teleinvivo/teleinvivo_project.html
• In Japan, tele-operated robots have been used to perform a remote ultrasound examination between two sites with terrestrial communications.
▫ Source: Healthcare Services for People in South West Rural Areas using 3G Wireless Robotic Tele-Ultra-Sonography Systems
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Readily deployed telemedicine/e-health services and systems
Readily deployed telemedicine/e-health services and systems
• In 2003, Alexandra Hospital in Singapore used an RFID tracking system during the SARS outbreak. ▫ Anyone who entered the hospital was given RFID ID cards so that if someone was diagnosed with SARS later, all individuals who contacted the person in the hospital could be immediately identified.
Readily deployed telemedicine/e-health services and systems
Fig. 2 Case discussion whiteboard
Fig. 1 Historical X rate record
SARS related data gathered & discussed among experts
Fig. 3 Expertise users training during SARS outbreak
Readily deployed telemedicine/e-health services and systems
Friday, March 2, 2007 Medtronic’s Chronicle Fails
A Taiwanese Asthma Care Service via Mobile Phone
Readily deployed telemedicine/e-health services and systems Home Health Congestive Heart Failure Management System developed in collaboration with the Mercy Health System
• Parameters: ▫ ▫ ▫ ▫ ▫
Blood pressure Heart rate Respirations Oral temperature Heart & lung assessment with stethoscope ▫ ECG ▫ Oxygen saturation
Wireless Telemedicine
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Overall Goal
Many Enablers • Wi-Fi Networks ▫ Wireless Local Area Networks (WLANs)
• Wireless Personal Area Networks (WPANs)
Exploit existing & emerging wireless technologies to support highly efficient medical care delivery
▫ Bluetooth ▫ Ultra Wide Bandwidth (UWB)
• Wireless Metropolitan Area Networks (WMANs) ▫ Mobile WiMAX (Worldwide Interoperability for Microwave Access or IEEE 802.16a)
• Cellular Networks • Satellites • Body Area Networks (BANs) ▫ Sensors (Zigbee), Actuators, and Prompters
• Radio Frequency Identification systems (RFIDs)
Transition to Broadband Wireless Tech. CDMA One
EV-DO Rev.0
CDMA 2000 1x
EV-DO Rev.A
UMB
Mobile PDC
W-CDMA
HSDPA
HSUPA
LTE
IMT Advanced (4G)
Satellite & Cellular Networks
Mobile WIMAX Broadband Wireless
Wireless LAN
Fixed 200 0
Analog ISDN
ADSL & CATV
FTTH
200 5
Advanced FTTH (10G/ WDM)
2010
Transition to 3G - JAPAN
04/3 | 04/6 | 04/9 |04/12| 05/3 | 05/6 | 05/9 |05/12| 06/3 | 06/6 | 06/9 | 06/12| 07/3| 07/6 | 07/9| 07/12| 08/3 Source: Japanese Ministry of Internal Affairs and Communications
3G
Others
3G Networks • Operate in higher frequency band ▫ 2 GHz and beyond with large bandwidth • Provide high rates ▫ Up to 2 Mbps in a fixed or stationary wireless environment ▫ 384 Kbps in a mobile environment. • 3G and satellite-based GPS can provide the infrastructure for outdoor patient monitoring and emergency systems • Key enabler for realizing the vision of Mobile healthcare or ―m-health‖: ▫ Serviced healthcare anytime and anywhere
PHS
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Major Pitfall • Capacity constraints
• Inability to support medical applications with real-time constraints to a large # of users
Wireless Metropolitan Area Networks
• Satellites exhibit long E2E delays
Wireless Metropolitan Area Networks •
Standardized in IEEE 802.16
•
Range: • 6 miles, covers a small city with one base station
• • •
Throughput: 72 Mbps IEEE 802.16d: Fixed WiMAX IEEE 802.16e: Mobile WiMAX
•
Security • Multi-level encryption
•
QoS: • Dynamic bandwidth allocation • Good for voice and video
Global WiMAX Deployments By region as of Oct 2008
Wireless Metropolitan Area Network • With its wide coverage, WMAN can support the m-Health vision ▫ Provides the underlying data transport system for a wide range of medical applications ▫ Makes health care information accessible anytime, anywhere, with any device
• Potential benefit of WiMAX is more visible for developing countries ▫ Same thing about telemedicine!
Ongoing Project: Covering Vietnam with WiMAX Feb 19, 2009 Nikkei Net
Source: Informa Telecoms & Media
• Involved corporations • NEC co., Mitsubishi co., FPT (Vietnam operator) • 500 Million US $ project • Applications: telemedicine, distance learning • Similar projects envisioned with Laos and Cambodia
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Global LTE Commitments
Wi-Fi Networks
63
Benefits of WLANs Networks • Cost efficiency & Easiness in deployment
More on WLANs • Several flavors of the physical layer ▫ 802.11b/g: 2.4 GHz, data rates = 11 ~54 Mbps
• Operate at unlicensed frequencies
▫ 802.11a: 5 GHz, data rates = ~ 54Mbps
• Operate in the ISM (Industrial Scientific and Medical) bands
▫ 802.11n: 2.4 & 5GHz bands, data rates: ~ 100Mbps ▫ 802.11e:
• Higher capacity in limited range scenarios ▫ hospitals and medical clinics ▫ home or residential care centers
• High rate WLANs ▫ Suitable for bandwidth-intensive medical applications (real-time non-critical applications, office/IT apps)
Addresses QoS in DCF (Distributed Coordination Function) at MAC Prioritized QoS with the Enhanced Distributed Channel Access (EDCA) Parameterized QoS with the Hybrid Coordination function Controlled Channel Access (HCCA)
Another Billion Dollar Question: WiFi or Femto?! • Low-power access points… …using mature mobile technology …in licensed spectrum …generating coverage and capacity …over internet-grade backhaul …at low prices …with full operator management …self-organising, self-managing
Body Area Networks
• Applications include: ▫ ▫ ▫ ▫
Residential Enterprise Hot spot Metro
Generic Femto Network Architecture
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BANs’ Components
What’s a BAN?
• Standards developed under IEEE 802.15.1/3/4 groups • Bluetooth
Server
ECG
▫ ▫ ▫ ▫
Surveillance Center
Motion Sensors
Developed under 802.15.1 Up to 8 Bluetooth devices can communicate in a P2P fashion forming a piconet Operate in the 2.4 GHz ISM bands Data rates up to 3Mbps
• Ultra Wide Bandwidth (UWB) ▫ ▫ ▫ ▫ ▫
Ad Hoc of Rescuers
Developed under 802.15.3 Data rates 20 Mbps ~ 480 Mbps Allow more devices to share limited spectrum Save power by transmitting only a fraction of the time and at lower power QoS requirements easily met when excess bandwidth is available
• Sensors (Zigbee)
▫ Developed under 802.15.4 ▫ Low power devices ▫ Two physical layers: one for 815 and 915 MHz supporting data rates of 20 kbps (Europe) and 40 Kbps (USA) Another for 2.4 GHz supporting data rates of 250 kbps
Types of BANs • Non-Invasive BANs ⇒ Monitoring and sensing signals from the human body for medical applications ⇒ Distributed on-body sensors
Implantable Transceiver
Mobile phone for remote monitoring
• Invasive BANs (or In-body) ⇒ Include implanted medical devices operating in the MICS bands (402405 MHz) ⇒ Ex: ―Pill camera‖
Machine Type Communications
▫ Takes hundred of thousands of images during a typical eight-hours test
MTC: Business Models
MTC Typical Architecture Machine
MTC application domain
Scenario 1: MTC device to MTC server communication Scenario 2: Inter-MTC device communication
MTC servers Serving gateway
HSS S6a
PDN gateway
TO
S5
S11
MME
S1-U
Network domain
S1MME
S1-U
eNB2
S1MME
eNB1
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The RFID Reference Model Logistical Tracking & Tracing Production, Monitoring, Maintenance Product Safety, Quality, Information
RFIDs
Access Control, Tracking & Tracing
Assistance for the disabled Loyalty, Membership, Payment Hospital management E-Health Care Implants Smart Implants Sport, Leisure, Household Medical Monitoring Public Services
RFIDs in Medicine • Used to track medical instruments in surgery rooms • Implanting chips inside surgical instruments will virtually eliminate the mistake of leaving an item inside of a sewn-up patient • Used to track clothing through the laundering process
Open Issues
• Used to track patients, identify their identities, locations and the exact procedure to be performed by the hospital staff • Used to more effectively track patients by billing systems • Used to track where the hospital personnel are located and their work start times • Used to restrict access of certain areas to certain groups of people
Wireless communication issues • Coexistence, interference & spectrum management ▫ Increasing number of technologies operating in ISM bands ▫ Unlicensed freq bands, interference between WPAN (802.15.4) and WLAN (802.11b), interference among devices using the same technology
• Power Consumption ▫ Limited power, radiation interference, effects of reducing transmitted power, hardware design
• MAC-layer QoS support ▫ Efficient spectrum utilization while guaranteeing QoS ▫ Centralized/distributed channel access – the Enhanced Distributed Channel Access (EDCA) or the Hybrid Coordination function Controlled Channel Access (HCCA) in IEEE 802.11e
Wireless communication issues • Regulatory issues and security ▫ Service level agreement (SLA), FDA, HIPPA
• Security ▫ Is there any secure wireless technology? ▫ Privacy concerns & security are more important in life-critical medical applications ▫ ▫ ▫ ▫ ▫ ▫
Confidentiality attack Sensor data integrity attack Fake emergency attack Prevention of legitimate warnings Battery power depletion etc
• Seamless mobility support ▫ Support of roaming over different networks
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Rapid growth of aging population in developed countries Progressive degradation of vision, hearing, motion, and cognitive skills deprives people from performing basic activities (e.g., self-care, leisure, …)
Part III: Eldercare Ultimate hospitalization Limited capacity of welfare centers
Both high health & social costs
Source: pictures of the future: the greying society 2005, Siemens
Shift health care from hospitals to pervasive systems deployed close to where elders live and move
Solution: In-House Safety Systems
For elders: Increase independence, safety, QoL For Welfare systems: Decrease care cost-saving
R&D at five main different levels: • Cellular • Physiological and/or genetic abnormalities. • Organ • Organ impairments - e.g., cardio-vascular system • Action • Functional limitations of organs • Task • Activities in specific physical and social contexts • Social • Engagement with other people
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Ubiquitous Assistance Systems • Record & analyze elders behavioral patterns • Monitor seniors mobility • Assist individuals with routine life activities • Remind an Alzheimer patients of basic steps for performing a daily activity • Prompt alerting in emergency
Ubiquitous Networking Solutions • • • •
Promote social interactions of elders with their surroundings Provide individuals with a rich social & emotional framework Reduce their sense of loneliness Coordinate between the different actors in an eldercare event
Ubiquitous Assistance Systems • Record & analyze elders behavioral patterns • Monitor seniors mobility • Assist individuals with routine life activities • Remind an Alzheimer patients of basic steps for performing a daily activity • Prompt alerting in emergency
Ubiquitous Networking Solutions • • • •
Promote social interactions of elders with their surroundings Provide individuals with a rich social & emotional framework Reduce their sense of loneliness Coordinate between the different actors in an eldercare event
No existing framework supports both UAS and UNS
Computer vision based system to support individuals with severe vision impairments • Secure a safe navigation of a particular environment • Generates alert messages when the layout changes
Cognitive Orthotic System (Auto-Minder) • Models the daily plans of an individual • Decides on when & where to remind the person of the execution of these plans • Developed on a mobile robot as part of the Nursebot Project’s Initiative on Personal Robotic Assistant of the Elders
UAS systems focus on a specific task, provide only a subset of the required support functions
How can we monitor and detect possibly dangerous situations? How can we design assistive solutions that facilitate integration, management and update of sensors and actuators infrastructure within elders home environments? How can we improve emergency detection and response?
Finally, how can we identify suitable trade-offs that keep into account all of these considerations?
Efficient integration between
A middleware-level solution able of
• Commercial Off-The-Shelf (COTS) devices (e.g., sensors, actuators) • Pervasive computing technologies • Wireless/mobile networking technologies
• integrating sensors and actuators needed to monitor and guarantee elder safety • detecting possibly dangerous situations for the elder, and • composing emergency response groups of volunteers and caregivers, allocated in the nearby, willing to help in case of an emergency event Tarik Taleb, Dario Bottazzi, Mohsen Guizani, and Hammadi Nait-Charif, “ANGELAH: A Framework for Assisting Elders At Home,‖ in IEEE JSAC, Jun. 2009
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AEs enforce appropriate actions that permit smooth monitoring of elders’ actions SEs continuously gather row context data and communicate them to the HM
SE 3.1
LR1
Room 3
SE 3.3
AE3
SE 1.2 Local Responders
Elder
SE 3.2
SE 1.1 Room 1 SE 1.3 AE1
SE 2.1
LR4
Individuals willing to help, can be family members, friends, neighbors, paid help, or simply passers-by.
SE 1 SE 2.2 Room 2
Home Network LR3
LR2
SC is in charge of coordinating prompt response in emergency situations.
HM gathers available context info, aggregates the info, and detects if the elder is in need of Locality Manager help Locality 1 (LM)
SE 2.3
AE2
Home Manager (HM)
Surveillance Center (SC)
SE 3.1
AE3
SE 1.1 Room 1 SE 1.3 AE1
LR1
SE 3.3
Room 3
SE 1.2 Local Responders
Elder
SE 3.2
SE 2.1
SE 1 SE 2.2
LR3
LR2
LM monitors and maintains a list of collocated LRs
LR4
Locality 1
Family & Friends
AE2
Home Manager (HM)
Surveillance Center (SC)
Locality Manager (LM)
Volunteers
SE 2.3
Room 2
Home Network
Surveillance Center
Central Unit
Profile • • • • • •
Unique User IDentifier (UID) Current physical location Medical expertise Skills Trust level History in providing assistance within the ANGELAH framework
Video Analysis
Exempted Accepted Volunteers Volunteers
Volunteers Selection
LRs’ devices • Capable to discover, join and leave elder support groups, • Capable to obtain the visibility of available partners allocated in the nearby along with their profile information • Capable to collaborate with others via message exchange
On Site Instructions via Camera Monitoring
Personal information of the senior (e.g., age, gender, etc) Postal address of his residence His physical and cognitive characteristics Kind of required assistance Current conditions of the elder (e.g., pulse)
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Developed on top of the Open Service Gateway initiative (OSGi) Major functions: • Integrates and manages all available sensors and actuators deployed in the elder’s home • Gathers, aggregates, and distributes all sensed context information • Detects whether the elder needs assistance • Finally, controls available actuators and alerts the surveillance center in case emergency
CDS: Context Distribution Service ERDM: Emergency Response Decision Making PR: Profile Repository PS: Proximity Service GFS: Group Formation Service
LRs’ attributes Composes, dissolves, & manages emergency response groups Creates, maintains, & disseminates views to ANGELAH group members
Bone Fracture • X1: Physical proximity & availability set acceptance threshold to high values • X2: Expertise and skills Life-critical event • X3: History record in providing set waiting timeout to low values assistance • X4: Associated trust level Multi-Attribute • etc Decision Making
Emergency Level Determination
• Contextual information • Senior’s profile
GFS: Group Formation Serv ice LBNS: Location Based Naming Serv ice ERDM: Emergency Response Decision Making V MS: V iew Manager Serv ice PS: Prox imity Service J/LMS: Join/Leav e Manager Serv ice
All devices OFF
No Tag detected? Ye s Wake up camera/sound sensor No
Operation by Tag Reader (Actuator)
Anomaly detected? Ye s Sound I/O interface ON Operations by HM Inquiry the person if he/she is Ok.
Timeout expires
Is the Ye person s OK? No Send SOS message along with video Analyze Video Define Emergency Level Operations by SC Contact Volunteers Form Elder Support Group
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4/10/2011
Employing computer vision & pattern recognition for profiling and behavioural anomaly detection
Intervention plan and user application • to reduce bystander apathy • Emergency notification by increasing sound signal
Detection Delay: 1.6s
Easily installable over a PDA
Need to extend ANGELAH with proper security functions • Identify tradeoff solutions between elder privacy and the need to disclose sensitive information
Other socio-psychological to aesthetic factors A
Heap Memory
Need for interdisciplinary research
BNon-
Heap Memory
• Caregivers: produce a library of emergency scenarios that an elder with a particular pathology is likely to encounter • Computer engineers: define mechanisms for prompt & accurate emergency detection and efficient rescue group management • Medical experts: define emergency levels for each scenario, determine critical action times and list appropriate instructions
Telemedicine review • • • •
Necessity Funding Telemedicine applications and their requirements Readily deployed systems
Wireless Tele-Medicine • Supporting technologies • WMAN, WLAN, WPAN, BANs • Open Issues
Eldercare Services • Ubiquitous Assistance vs Ubiquitous Networking • ANGELAH framework
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