When Smart Home Meets Pervasive HealthCare

Services Using Mobile Devices and Sensor Networks–

Status and Issues

Ti-Shiang Wang

Nokia Research Center

5 Wayside Road, Burlington, MA 01803, USA.

Abstract: In this paper, to deliver healthcare service pervasively, especially to

the home space, we first discuss the status and activities on healthcare infra-

structures and systems using mobile devices and sensor networks. We also pro-

vide the information and illustrate the reasons why home healthcare will be

even more hot space in the near future. With the advance of wireless network,

mobile devices become more demanding for users to communicate each other

either for voice or data service, or both. In addition, as medical record goes to

digital form and will be available any where, any time and used by any kind of

mobile devices, so that mobile healthcare becomes a hot topic and many issues

are currently working on. From the user side point of view, advanced sensing

devices and networks based on them provide rich context and seamless connec-

tion between users and mobile devices so that the personal data or medical re-

cord could be updated as needed and quality of services can be improved. With

the help of smart sensors and sensor networks embedded either on body or in

the home space, the quality of personal healthcare can be improved in lower

cost as well. In this paper, we also address some issues to implement the home-

based pervasive healthcare applications and provide a visionary scenario inte-

grating smart home and healthcare services.

1 Introduction

Healthcare institutions today are attempting to respond to demands to reduce cost and

improve the effectiveness of care delivery. Spurred by a combination of economic

and regulatory pressures (such as Health Information Portability and Accountability

Act, HIPPA) [1], hospitals and healthcare providers want new solutions that can ad-

dress core business needs and manage the huge volumes of time- and security-

sensitive data that they are involved.

With the popularity of mobile devices and pervasive deployment of wireless net-

rks, the gateway of healthcare service become closer to patients so that the patients

can control the autonomy and smart home/healthcare gets involved. In other words,

patients and healthy people can do the basic control and monitoring by themselves.

From mobile device’s point of view, personal digital assistants and mobile phones are

Wang T. (2005).

When Smart Home Meets Pervasive HealthCare Services Using Mobile Devices and Sensor Networks– Status and Issues.

In Proceedings of the 2nd International Workshop on Ubiquitous Computing, pages 67-74

DOI: 10.5220/0002560300670074

 SciTePress

cheap and effective, and run a wide variety of applications. Many people simply bring

their own PDAs to work. As technology continues to reshape the way hospitals de-

liver care, doctors, nurses, and other clinicians need access to patient information

from any location and at any time. Although many hospitals have integrated their

various information systems, delivering clinically relevant patient information, for

example, electronic medical record (EMR) [2], to healthcare professionals – when,

where, and how it is needed – still poses a major challenge. Services from caregivers

to the patients or users are related to the data rate of the services, which is a key crite-

ria used for both wired and wireless network and technology deployed in the health-

care environment. Even with patients (either sick ones or/and healthy ones) have

them for well-being or daily monitoring. The range of data rates of typical devices

used in the telemedicine can be scaled from several kbps up to tens of Mbps [3].

Mobile healthcare encompasses the range of mobile technologies as they are ap-

plied in healthcare, wireless network infrastructure, mobile devices and mobile appli-

cations. It is an extension of, but not a replacement for, desktop computing. The po-

tential benefits of mobile healthcare include point-of-care communication, improve

clinical decision-making, enhanced quality of care, reduced medical errors [4], im-

proved information access and exchange, improved accuracy, diminished redun-

dancy, diminished paperwork, increased time for patient care, and improved integra-

tion. In Addition, mobile healthcare supports public safety initiatives and reduces cost

while improving efficiency. Mobile healthcare aims to give users (either patients or

physicians) a more active role in the healthcare process while at the same time health-

care payers are able to manage costs more directly. The benefits of mobile healthcare

computing are to provide point-of-care communication, to offer information access

and exchange, to diminish paperwork, to improve accuracy and efficiency, to im-

prove clinical decision-making, and to promote integration. XML and web service

technology [5, 6] have also been consider to apply in healthcare sectors to provide

sharing, interoperability and availability of medical data or records.

On the other side, the pervasive computing technologies can be of use on the user

sides not only to support healthcare, health and wellness management, but also to

make healthcare available everywhere and any time, pervasively, especially in the

home. It is envisioned that this concept of computing anywhere can be applied to

support users in their own home environment, so that the activities around the home

can be monitored, under control and make proactive decisions to better serve the

occupants by enabling context-awareness instead of being solely reactive to their

commands. For home-based healthcare, personal wellness systems are not meant to

replace the mainframe system of hospitals, clinics and physicians but rather to put

seniors and activities of daily living more squarely into the healthcare mix. Espe-

cially, systems that encourage seniors to maintain physically fitness, nutrition, social

activities, and cognitive engagement so they can function independently in their own

home for as long as possible can help address the social and financial burdens of an

aging population.

To make the home to be smart to provide suitable services, sensors and sensor

network will play an important role to make it happen. Basically, pervasive healthcare

techniques consist in embedded sensors to continuously monitor people’s home activ-

ity, which is analyzed to provide global health information. Nevertheless, in such

systems, support is limited to a closed environment, and sensing of vital signals is not

possible. These signals sensed mostly are physiological information. In the future,

both of physiological rhythms and behaviors of the own of the house will be consid-

ered in the pervasive healthcare. The sensed data can be integrated in the database

and arrange it in a generalized XML format, which allow the exchange with medical

institutions where a system manages the database for each patient’s vital signals, so

that the advanced web service technologies can be applied.

2 Mobile Healthcare Projects/Programs

Mobile healthcare activities have been very active because wireless network is perva-

sively deployed and mobile devices are mature enough to provide an important com-

ponent in healthcare sectors. Mobile healthcare application can be viewed an exten-

sion of the use of telemedicine [7, 8] to support the healthcare in mobile manner and

remotely. In other words, mobile healthcare can be considered the first step towards

pervasive healthcare application, since it is mainly focused from the healthcare or

caregiver side. In this section we list some projects (but not an exhaustive list) that

have been proposed in the area of mobile healthcare applications. In general, sensor

based network with mobile devices (such as mobile phones or PDAs), Internet, wire-

less networks and medical record center are major network components. Fig. 1 is

shown for network domains for mobile healthcare projects discussed in this section.

GSM/GPRS/

UMTS

PDA

Internet

Medical

Data

Center

Host

AMON

MobiHealth

GPRS/TeleMed

DITIS

Fig. 1. Architectures of proposed mobile healthcare projects

Advanced care & alert portable telemedical MONitor (AMON) [10] system is a

wearable personal monitor medical device that evaluates human vital signals using

several kinds of advanced biosensor. The system gathers and analyzes the vital in-

formation and transmits the data to a remote telemedicine center for further analysis

and emergency care, using cellular infrastructure.

MobiHealth project [9] funded by European Commission aims at introducing mo-

bile value-added services in the healthcare using 2.5G (GPRS) and 3G (UMTS) tech-

nologies. A sensor-based network, called body area network (BAN), enabling the

integration of different sensors and actuators, is presented and has been prototyped in

the first phase of the project. The BAN was connected to the public GPRS and UMTS

networks, using iPAQ and Ericsson mobile phone as gateway to connect to Internet.

In [11], this project was partially supported via the Cyprus Telecommunication

Authority (CYTA), the Research Promotion Foundation of Cyprus (project IASIS),

and the University of Cyprus. In this project, a practical evaluation of the perform-

ance of the GSM and GPRS systems in the transmission/reception of X-ray images

and videos in emergency orthopedics cases was carried out. The results presented in

this study were carried out using the Compaq iPAQ 3870 handheld PC equipped with

GSM/GPRS expansion pack modem.

In AMBULANCE project [12], it consists of mobile unit and consultation unit.

GSM link was used to connect these units. The device uses GSM links and allows the

collection and transmission of vital bio-signals, still images of the patient, and bi-

directional telephoning capability. The mobile unit mainly consists of two compo-

nents, a Johnson&Johnson Dinamap Plus III bio-signal monitor used for bio-signals

acquisition and a portable PC. The consultation unit mainly consists of a dedicated

workstation as a processing terminal in the hands of the acting expert doctor to sup-

port an emergency case.

DITIS [13] is a member of the MEMO cluster project. DITIS is an Internet (web)

based Group Collaboration system with secure fixed and mobile (GPRS/GSM/WAP)

connectivity. It employs mobile agents, web databases with Java database connec-

tivity for storage and processing of information.

MOMEDA [14] project was focused on the development of a compact personal

information terminal for hospital and home care environment that could be used by

patient and a demonstrator that allows the consulting physician to access electronic

patient record data from outside the hospital, using a handheld companion device

connected to GSM network. This project was sponsored by Nokia, and the Nokia

9110 communicator was used in the test-bed and demonstration.

3 Home-Based Healthcare Services

Compared to hospitals, home is the more comfortable and favorable to the patients or

occupants, and the expense of healthcare services can dramatically be reduced if this

service can be delivered to the home, without interrupting their daily activities. With

Internet, wireless LAN and personal area network technologies, pervasive healthcare

applications at home applications include patient monitoring, mobile/fixed telemedi-

cine, location or proximity services, emergency response and management, and well-

ness fitting/tracking, have been widely deployed and discussed. To break the bounda-

ries in time, space, and organization that healthcare service may face, mobile device

based healthcare application could be one of the candidate solutions thanks to widely

deployment of wireless network.

To bring health care to the home, motivation and availability of technologies to be

used can be seen unchanged, however, the scenarios at home space are different from

the cases in mobile healthcare mentioned above. Depending on the severity of their

diseases, occupants do not need to stay at hospitals, but they will lead a normal life

while their medical data are monitored and analyzed by healthcare professionals. This

situation leads the popularity of smart health at home or called smart home for health-

care services, such as elder care services [15, 16, 17]. Home-domain healthcare envi-

ronment gives residents as much autonomy and even responsibility for themselves

and their environment as possible. Pervasive sensors can be used to monitor vital

signs and health indicators. These sensors also include some position sensor to sense

the position of patient and monitor their activities. In other words, pervasive comput-

ing as well as computational technologies will let adults age in place. But few of them

bring the use of mobile phone to the discussion and this remains to future investiga-

tion. Home-based sensor and diagnostic technologies can be installed in the home

space to fit occupant’s need, and could help establish “disease signatures” that show

up physiologically and behaviorally before severe symptoms become readily appar-

ent.

4 Roles of Sensor Networks

Sensor networks have been established not only for sensing the data from the target

environment or objects but also been designed to provide the services for them to

meet some performance criteria or requirements. Especially, bio-signals have been

used to offer health monitoring [18]. Several personal area networks using bio-

sensors have been discussed to monitor some key or vital signals during the daily

activities [19, 20, 21, 22, 23].

Traditionally, personal medical monitors have been used for data acquisition.

With the developments of wireless and mobile technology, wireless sensor network

with intelligence will provide more feasibility to the users. In addition, PDAs and/or

mobile phones have been considered to be an important component as a gateway and

they are portable, so that the sensed data from the sensor networks either can be re-

layed/transmitted to the medical database through Internet or can be proc-

essed/filtered to enhance these medical data for specific further medical activities

around the users. In general, we observe that this type of architecture based on sen-

sors is tree-type and can been seen the first or last hop of entire network. That is, for

example, PDA or mobile phone is used as a central control node to its associated

sensors and to process the sensed signals. The connection between sensors to these

mobile devices could be designed using standardized protocol, for example, IEEE

802.15.1/bluetooth and IEEE 802.15.4/ZigBee.

Telemedicine and monitoring services provided by sensor networks also make

sense to be installed for home-based healthcare services. These services include not

only personal medical data recording but also occupants’ physiological and behav-

ioral monitoring [24, 25]. That is, home-based sensor network and diagnostic tech-

nologies could help establish disease signatures that show up physiologically and

behaviorally before more severe symptoms become readily apparent. However, sev-

eral challenging issues still remain using sensor network technologies. For example,

how to translate the sensor data securely to context-awareness. In addition, based on

the sensed data from the embedded sensors at home, how to estimate some key pa-

rameters confidently from occupants’ behavioral manner and physiological rhythms

at home to provide specific healthcare service is also one of the challenging issues.

Furthermore, requirements will depend on the needs and attitudes of occupants, even

in the same home space. How to design a sensor network with an intelligent interface

engine not only sense the data but also analyze the data as well remains to investigate.

5 Future Visionary Scenario: Smart Home plus Pervasive

Healthcare

From home point of view, several smart home activities have been working for years.

To make home be smart and services to be aware to the user/owner, there are several

home network middleware schemes, such as Univeral Plug and Play (UpnP) [26],

Java-based JINI [27], Open Services Gateway Initiative (OSGi), Home Audio/video

Initiatives (HAVi) to control home networks that are composed of computers and

various electronics appliances. In addition to electronic appliances as components of

smart home, other objects, such as a cup or medicine refilled bottles, etc, should be

also been viewed to provide data from healthcare’s point. In other worlds, the

user/owner shall feel confidently and comfortable use mobile devices for his/her daily

life. To achieve this scenario of smart home integrating with pervasive healthcare

services using mobile devices, several challenging issues should be tackled without

the limit to the following. First, generic home network architecture of smart home to

provide healthcare services is a must. That is, this home network architecture should

be built not only by suitable sensors or sensor networks, but also probably with mul-

tiple different service discovery protocols (SDP) to meet the

needs/requirements/services at home. Based on this, the physiological and behavioral

data of user can be recorded and monitored as input to healthcare services. Second,

interoperability is an issue too. Each existing service protocol and middleware

scheme cannot meet all the requirements of this future scenarios. Thus, the interop-

erability of different SDPs at home to provide healthcare service remains as one of

the challenges. Third, as the amount of appliances and objects increases at home, the

scalability will be an unavoidable issue and should be considered. Especially coupled

by the interoperability factor referred by different SDPs, network architecture and

service connection built by some surrogate nodes at home should be carefully

planned and design to meet the requirements of interoperability, scalability and ro-

bustness. Fourth, with mobile devices been used at home, security and user experi-

ence are worth to investigate. How to build a trust domain in a home to meet the

requirements not only from services used at home point of view, but also from

healthcare service point of view. In addition, how to make user be aware of the ser-

vices around the home and live confidently and comfortably using his/her mobile

devices is worth to investigate in the future.

6 Conclusion

With the need of electronic medical records and the deployment of pervasively-built

wireless network including the mobile devices, mobile healthcare systems and ser-

vices have brought more focuses and interests recently. There have been lots of ac-

tivities for mobile healthcare vendors to develop suitable products and services to

satisfy their customers, either inpatients or outpatients, or both. These technologies

will not only help physicians to work from any where, and collaborate with other

physicians and specialists on line, it will also save them administrative time, which

will translate into more value added time for healthcare provider and ultimately the

patients. On the other side, as senor networking and pervasive computing technolo-

gies are getting more mature, the support for home based healthcare service will not

be too far and brings the quality of life to the occupants, no matter they are of age or

not. Moreover, emerging net-centric standards for service-registry like Universal

Description, Discovery, and Integration and the standardized Web Services Descrip-

tion Language (WSDL) can be used to integrate the smart devices and services pro-

vided within a smart home with other community services. With the help of sensor

based components and networks, the dream and flexibility of the mobile healthcare

services getting closer to end users (for example, both patients and physicians) at any

where, at any time and using any mobile devices will come true soon. It is conclusive

that some of the current and successful telemedicine systems will be more geared

toward emerging wireless solutions in healthcare scenarios that are not feasible with

current generation of cellular telephonic and Internet services, so as to the user can

also take the benefits and services support by the home to experience a comfortably

daily life.

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