IoT – The future of Smart Healthcare?

物聯網導論

IoT – The future of Smart Healthcare?

TSAI-YA (ROSE) LAI, RN, MPH, PHD2019.01 @ NTU

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Copyright 2019 ITRI 工業技術研究院

OUTLINE

• Introduction of the speaker• IoT in healthcare: current status• International cases of IoT R&I • What are expected for the future?

– Meaningful use of the Ts in healthcare– Exploration of new Ts for healthcare

• Conclusion• Q & A

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WHO AM I?

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EducationNursing + Public Health + Informatics

ExperienceClinical + R&I + Academic

Copyright 2019 ITRI 工業技術研究院 4

IoT for smart healthcare: Hype or Reality?

• IoT is the network of physical objects or “things” embedded with electronics, software, sensors, and network connectivity, which enables these objects to collect and exchange data

• The “things” were categorized according to their “settings”– including human (medical devices that are either attached to or placed

inside the human body), home, retail environments, offices, factories, worksites, vehicles, cities, outside...

Reference: Internet of Things Global Standards Initiative, ITU, http://informaticsforconsumerhealth.org/

Copyright 2019 ITRI 工業技術研究院5

IoT in Digital Health


A smart hospital is a hospital that relies on optimizedand automated processes built on an ICT environment ofinterconnected assets, particularly based on Internet of things(IoT), to improve existing patient care procedures and introducenew capabilities

Smart hospitals are those that optimize, redesign, or build newclinical processes, management systems and potentially eveninfrastructure, enabled by underlying digitized networkinginfrastructure of interconnected assets, to provide a valuableservice or insight, which was not possible or available earlier, toachieve better patient care, experience, and operational efficiency

於醫院中應用資通訊科技提升病人安全，改善醫療品質，促進營運效率。(醫院自動化)

IoT for Smart Hospitals: Definition

(European Union Agency For Network And Information Security EU, 2017/11)

(Frost & Sullivan, 2017/11)

(衛生福利部，2015/2/26)6


Future of Smart Hospitals by F&S 20171129


資料來源：Frost & Sullivan (2016)

Smart Hospital: Affordable, Quality, Efficiency


Current Smart Hospital

行動化雲端護理及生理量測

床邊衛教資訊系統

智慧病床

床邊求救照護系統

雲端資安系統

雲端儲存雲端運算

雲端管理系統

雲端作業系統

智慧診間

診間資訊顯示器

醫療資訊系統

雲端耳溫槍、血壓機與血糖機

看診進度管理系統

智慧醫療資訊系統智慧手術房

智慧病房智慧急診室

智慧護理站

智慧藥物管理系統

雲端心電圖、心跳、呼吸檢測

中央雲端監控平台雲端多功能病人監視系統)

雲端可攜式多功能生理監視器

智慧手術床

雲端心電圖、心跳、呼吸檢測

中央雲端監控平台雲端多功能病人監視系統)

雲端可攜式多功能生理監視器

診間資訊顯示器

醫療資訊系統

雲端耳溫槍、血壓機與血糖機

看診進度管理系統

行動化雲端護理及生理量測


IoT for HealthCare

• 人員追蹤:社區會機構中應用

• 生理偵測:穿戴式裝置為媒介

• 環境偵測:行為活動改變


”形式大於實質”

穿戴式裝置健康成效未定論


物聯網:穿戴裝置健康應用案例一Internet of Things, IoT

• Cleveland Clinic:• 50名健康成人配戴四種不同裝置測量心率，並與心電圖測量結果作比較，發現不同的腕戴式技術測量心率的準確性差異極大

量測準確度


物聯網:穿戴裝置健康應用案例二Internet of Things, IoT

• JAMA:• 病患減重計畫中，一組配備能存取網頁介面的穿戴式裝置，另一組則單純存取具備運動健身(Fitness)追蹤功能的標準網站，雖然兩組病患體重均有下降，但配備穿戴式裝置的病患，反而平均少減了5.29磅

裝置本身非關鍵


物聯網:穿戴裝置健康應用案例三Internet of Things, IoT

• JAMA Internal Medicine:• 針對1,509名急性心肌梗塞倖存者，觀察12個月後發現，實驗組與對照組在首次因血管疾病而再入院或死亡的時間、因任何原因而首次入院、重複入院的總次數、平均用藥遵從性或12個月平均醫療費用總和上並沒有明顯差異

忽略行為改變介入的實質與生命週期


智慧裝置和健康APP

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HealthMine 調查500名使用行動裝置進行健康管理的消費者 (2016/3) 透過健康管理APP或裝置的輔助，可以更健康—76% 不知如何採取下一步行動—34% 資料與未與其他資訊整合—12% 看不懂數據代表的意義—11%

Monitoring Analytics Coaching


Do the Right Things Before do the Things Right

• What do you want to monitor? Why?• What info do you need? From what device?

– What are the sensors?– How to process the data? Front-end or back-end?

• Who will use the data? Why? – What is the level of ease of use? usefulness?

• How will the infrastructure be setup? Who will maintain this infrastructure?

• What security will you have in place?

Always remember that we are serving the human beings!!


What’s happening globally?

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EU Project Case 1

Call identifier: FP7-ICT-2009-4 ICT & AgingFunding scheme: Collaborative project

• EU contribution: EUR 14,000,000• Duration: 48m (2010/2/1~2014/1/31)• Participants: 23 partners / 11 countries

Target Identified

Consortium Presented

ProposalPresented

Request Submitted

Approval Notification

3-5/2011 5/2011 10/2011 2/2012 1/2013

FP7 universAAL: UNIVERsal open platform and reference Specification for Ambient Assisted LivingGrant Agreement: 247950


Universal open platform and referenceSpecification for Ambient Assisted Living

To make it technically possible and economically feasible to design and deploy innovative AAL services

http://universaal.org/index.php/en/


universAAL: 12 countries 21 partners

Ambient Assisted Living

eHealthHuman

Computer Interaction

Artificial Intelligence

Wireless Sensor

Networks

Internet of ThingsRobotics

Smart environme

nts

Context aware

computing

Social Web of Things


AAL – the Problem• Lack of standards• Lack of standard solutions• Poor interoperability

– Devices– Communication protocols– Data formats– Application Environments

• High development costs– Not cost-effective

The market does not exist

Reference: universAAL Training - AAL and universAAL


Key Concerns: Interoperability

Quality Audit(SW/HW quality management)

Product Development(SW/HW engineering)

Technical standards Regulations & Quality Management

MD Standards

• ISO 13485• ISO 14971• IEC 60601-1• IEC 62304 ICT

Standards• IEC 60950-1• IEC 60065• IEC 62368-1

Notified Body:UL/SGS/ASME

EU Market


EU Project Case 2

Call identifier: CIP-ICT-PSP.2012.3.2Towards open and personalized solutions for active and independent living

• EU contribution: EUR 5000,000 (Total cost: EUR 11,000,000)• Duration: 36m (2013/1/16~2016/1/15)• Participants: 19 partners / 8 countries

TargetIdentified

ConsortiumPresentation

Partnership Agreement

WebsiteIncluded

11/2013 2/2014 3/2014 6/2014

CIP ReAAL: Make it ReAALGrant Agreement: 325189


EU Project Case 3

Key Partner

Identified

Target Call Identified

Proposal Prepared

& Submitted

Proposal Review

Contract Processed

Project Knick-off

2014/1 2014/2 2014/2-4 2014/4-9 2014/9-2015/1

2015/2-2018/1

Type of project: Research and Innovation Action (RIA)Work program objective addressed: PHC26 2014 Self-management of health and disease: citizen engagement and mHealth

• EU contribution: EUR 4,600,000• Duration: 36m• Participants: 11 partners / 5 countries

Horizon 2020 Do CHANGE: Do Cardiac Health Advanced New Generation EcosystemGrant Agreement: 643735


Project Structure of DO CHANGE

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EU Project Case 4

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Horizon 2020: Participatory Urban Living for Sustainable EnvironmentsProject ID: 727816

Call identifier: H2020-SC1-2016-CNECTTopic: SC1-PM-18-2016 – Big Data supporting Public Health policiesFunding Scheme: Research and Innovation Action (RIA)

• EU contribution: EUR 449,5515• Duration: 36m (2016/11/01~2019/10/31)• Participants: 12 partners / 6 countries

Initial Contact

Strategy Planning

ParticipationNegotiation

Agreement Processing

3-5/2017 6-8/2017 9-11/2017 12/2017~


PULSE Taiwan Pilot

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Health Cloud

HPAPublic Health Surveillance

Smart City

International connection

Innovative policy

Dynamic surveillance

IoT sensingenvironment, behavioral, physiological

IoT service platform

Service providers

SI providersSW

developers

Equipment providers

Data security Data analytics

Innovative servicesSmart

governance

Health promotion

Needs Exploration, Service/Business Model Design, Pilot Evaluation,

Data input

Data Output


物聯網促動全球資通訊產業競爭要素翻轉

資料來源：工研院IEK (2015/01)

長尾效應少量多樣

集中規模大量生產

生產方式

市場競爭力價值創造成本/價格

產業結構開放封閉Open APISDx

價值鏈主導力量品牌主導

軟硬體整合系統服務者

現在

未來

生態系結構服務型應用生態體系

垂直分工水平整合、異業結合

巨量資料分析

Domain knowledge

Service Provider driven


My Dissertation in 2006 – do the same research in 2012, or 2019?

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Definition of Tailored Communication I

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Assessment is the Key

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Challenges

• Tech Orientation vs. Needs Orientation– Data Information Knowledge Action

• Fast iteration of ICT vs. Evidenced-based clinical practice and risk control– Technology verification & service validation– Usability, efficiency, & effectiveness– Empowerment


Needs and Value Creation

Maslow’s Hierarchy of Needs

• Data Input – Physical monitoring– Lab examination– Behavior/Body activity– Questionnaire/interview– Observation

• Application– Medical/healthcare– Wellness– Safety– Entertainment/Recreati

on


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Domain Based Concept Development


Tailored Communication Development

1• Analyzing the problem to be addressed and

understanding its determinants

2• Developing an assessment tool to measure a person’s

status on these determinants

3 • Creating tailored messages that address individual

variation of determinants of the problem

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• Developing algorithms and a computer program that link responses from the assessment into specific tailored messages

5 • Creating the final health communication

Domain automation

Sensor & data automation

Coaching automation

Reference: R. Kukafka, Tailored Health Communication, http://eknygos.lsmuni.lt/springer/98/22-33.pdf


Message Development

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Evaluation Model of TIDES

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2012年看到的未來趨勢與商機

由於手機和電視會與社群媒體整合成核心服務，Web3.0，有三個重要的特色，一是虛擬和真實世界的融合，過去主要是虛擬的，現在要把物理的實體世界融合進來，其實就是結合網路與觸控感應的物聯網，因此社群媒體的新商機也將隨之興起。

預測未來商務機會與需求:1. 機會: 電子書服務創新，社群購物，社群投資，社群房屋2. 需求: 美國分析相關的工作，將在未來8年內增加24%

2011

118億美元

2012

169億美元

2016

爆炸性的發展

Ref: Gartner

在2011年，IBM 和耶魯大學合作開發出社群媒體資料情感分析軟體 Cognos Consumer Insight。


FY102 ITRI Proposal 計畫名稱:網路社群情境感知圖文分析技術


Future Goal: Ubiquitous Care

- Bio-state- Activity- Location- Context

- Interactions- Events

Through the application of sensing technologies, with proper data processing, transmitting, analyzing and interpretation, it becomes much easier to learn and assist a person without asking.

Value Creation !!


Approaches

What is the health need I am looking at? Who is the target consumer? What innovation do I need? How we could evaluate it’s success? What are the technologies behind?

1. Lower the risks2. Improve quality3. Enhance knowledge


Exploration of New Ts


environment

susceptible

Causative agent

life style

pathogen

decease

activation of causative agent

change of cells and tissues

signs and symptoms

disease

disabled chronic condition

pre-symptomatic clinical disable death

(clinical level)

Health promotion and disease prevention Acute/sub-acute LTC PC

Life Cycle of a Disease: Where are the Ts?


健康行為改變與科技創新的結合

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DM

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COPD

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Get Closer to Smart Healthcare IoT

How do we evaluate the success? Architecture/structure, process, and intended results Technical, service, and business

What are the technologies behind? Key I: Automation effortless (operation) Key II: Smartness usefulness (content)

Can the technologies be applied to other health conditions?

Single point best performance does not equal to the best performance of the system


Please keep in mind

• Cross-domain R&I as healthcare informatics is like building a table. You have to have strong legs with equal strength that produce the best performance.


想想未來

• 4G 台灣普及率 < 40%• For 5G (year 2020?)

– 速度較 4G快 100倍– 下載一部電影: 8 min. to 5 sec.

• 4G 將智慧手機應用充分發揮，5G?– 虛擬實境 VR的應用– Robot? What kind of IoT solutions?– Industry 4.0 v.s. Healthcare 4.0?


Florence Nightingale, 1820-1910

Health is not only to be well, but to be able to use well every power we have (1893).


THANK [email protected]

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IoT – The future of Smart Healthcare?

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