Miguel Martínez-Espronceda

Standard-Based Middleware Platform for Medical Sensor Networks and u-Health

Advances in information and communication technologies, ICT, are bringing new opportunities in the field of middleware systems oriented to ubiquitous environments and wearable devices used for patient telemonitoring. At a time of such challenges, this paper arises from the need to identify robust technical telemonitoring solutions that are both open and interoperable in home or mobile scenarios. These middleware systems demand standardized solutions to be cost effective and to take advantage of standardized operation and interoperability. Thus, a fundamental challenge is to design a plug-&-play platform that, either as individual elements or as components, can be incorporated in a simple way into different telecare systems, perhaps configuring a personal user network. Moreover, there is an increasing market pressure from companies not traditionally involved in medical markets, asking for a standard for personal health devices (PHD), which foresee a vast demand for telemonitoring, wellness, ambient assisted living (AAL) and applications for ubiquitous-health (u-health). However, the newly emerging situations imply very strict requirements for the protocols involved in the communication. The ISO/IEEE 11073 (X73) family of standards is adapting to new personal devices, implementing high quality sensors, and supporting wireless transport (e.g. Bluetooth) and the access to faster and reliable communication network resources. Its optimized version (X73-PHD) is adequate for this new technology snapshot and might appear the best-positioned international standards to reach this goal. This work presents an updated survey of this standard and its implementation in a middleware telemonitoring platform.

Implementation Methodology for Interoperable Personal Health Devices With Low-Voltage Low-Power Constraints

Traditionally, e-Health solutions were located at the point of care (PoC), while the new ubiquitous user-centered paradigm draws on standard-based personal health devices (PHDs). Such devices place strict constraints on computation and battery efficiency that encouraged the International Organization for Standardization/IEEE11073 (X73) standard for medical devices to evolve from X73PoC to X73PHD. In this context, low-voltage low-power (LV-LP) technologies meet the restrictions of X73PHD-compliant devices. Since X73PHD does not approach the software architecture, the accomplishment of an efficient design falls directly on the software developer. Therefore, computational and battery performance of such LV-LP-constrained devices can even be outperformed through an efficient X73PHD implementation design. In this context, this paper proposes a new methodology to implement X73PHD into microcontroller-based platforms with LV-LP constraints. Such implementation methodology has been developed through a patterns-based approach and applied to a number of X73PHD-compliant agents (including weighing scale, blood pressure monitor, and thermometer specializations) and microprocessor architectures (8, 16, and 32 bits) as a proof of concept. As a reference, the results obtained in the weighing scale guarantee all features of X73PHD running over a microcontroller architecture based on ARM7TDMI requiring only 168 B of RAM and 2546 B of flash memory.

Seamless Integration of ISO/IEEE11073 Personal Health Devices and ISO/EN13606 Electronic Health Records into an End-to-End Interoperable Solution

The new paradigm of personal health demands open standards and middleware components that permit transparent integration and end-to-end interoperability from new personal health devices to healthcare information system. The use of standards seems to be the internationally accepted way to face this challenge. In this article, the implementation of an end-to-end standard-based personal health solution is presented. It integrates the ISO/IEEE11073 standard for the interoperability of personal health devices in the patient environment and the ISO/EN13606 standard for the interoperable exchange of electronic healthcare records and proposes a new approach for the end-to-end ISO/IEEE11073-ISO/EN13606 communication. The design strictly fulfills all the technical requirements of the most recent versions of both standards. An entire prototype has been designed, developed, and tested as a proof-of-concept of a personal health solution.

Lessons learned implementing the ISO/IEEE11073 standard into wearable personal devices

In this paper several approaches to implement the ISO/IEEE11073 interoperability standard into personal health devices using low-voltage low-power (LV-LP) microcontrollers are proposed. The patterns methodology previously suggested by the authors is followed in all of the approaches which include an 1-process implementation using non-blocking functions, multiprocess within an operating system, an specific multithread framework, and a code compression based interpreter. Finally, a qualitative comparison between the different approaches is provided.

Lessons learned from the implementation of remote control for the interoperability standard ISO/IEEE11073-20601 in a standard weighing scale

The Point of Care (PoC) version of the interoperability standard ISO/IEEE11073 (X73) provided a mechanism to control remotely agents through documents X73-10201 and X73-20301. The newer version of X73 oriented to Personal Health Devices (PHD) has no mechanisms to do such a thing. The authors are working toward a common proposal with the PHD Working Group (PHD-WG) in order to adapt the remote control capabilities from X73PoC to X73PHD. However, this theoretical adaptation has to be implemented and tested to evaluate whether or not its inclusion entails an acceptable overhead and extra cost. Such proof-of-concept assessment is the main objective of this paper. For the sake of simplicity, a weighing scale with a configurable operation was chosen as use case. First, in a previous stage of the research - the model was defined. Second, the implementation methodology - both in terms of hardware and software - was defined and executed. Third, an evaluation methodology to test the remote control features was defined. Then, a thorough comparison between a weighing scale with and without remote control was performed. The results obtained indicate that, when implementing remote control in a weighing scale, the relative weight of such feature represents an overhead of as much as 53%, whereas the number of Implementation Conformance Statements (ICSs) to be satisfied by the manufacturer represent as much as 34% regarding the implementation without remote control. The new feature facilitates remote control of PHDs but, at the same time, increases overhead and costs, and, therefore, manufacturers need to weigh this trade-off. As a conclusion, this proof-of-concept helps in fostering the evolution of the remote control proposal to extend X73PHD and promotes its inclusion as part of the standard, as well as it illustrates the methodological steps for its extrapolation to other specializations.

New use cases for remote control and configuration of interoperable medical devices

The newest branch of the ISO/IEEE 11073 (X73) standard for Personal Health Devices (X73PHD), allow the development of interoperable personal health ecosystems. At the moment of this writing, more than 11 specializations have been successfully published by the Personal Health Device (PHD) Working Group (PHD WG). Nevertheless, some recent specializations at draft stage show the need for a procedure to control configuration parameters. As a solution, some ad-hoc methods have been elaborated to deal with it, but, the aim of the PHD WG is to standardize a general procedure, valid for longer term. Then it is needed to identify use cases requiring remote configuration services. This work identifies and studies new use cases that employ remote configuration services. The resulting use cases, discussed within the PHD WG to get the maximum consensus, are within the scope of the Basic Electrocardiograph (X73-10406), the Sleep Apnea Breathing Therapy Equipment (X73-10424), and the Medication Monitor (X73-10472) specializations. In addition, a classification of the findings is proposed for each use case. These findings could be the basis for the new remote configuration extension.

Proposal of a novel remote command and control configuration extension for interoperable Personal Health Devices (PHD) based on ISO/IEEE11073 standard

New use cases to extend the interoperability standard ISO/IEEE11073 (X73) were found during the development of recent specializations. These use cases expose the need of remote command and control extensions to allow managers to configure agents through the standard. This paper presents a proposal for an extension of remote control and configuration service able to standardize a general procedure within the newest branch of this standard called X73 for Personal Health Devices (X73PHD). In order to develop a service for remote control, several approaches have been studied and discussed in the Personal Health Device Working Group (PHD-WG). The final solution is defined following the PHD-WG guidelines and integrated with the Optimized Exchange Protocol (X73-20601) and device specializations (X73-104xx). Previous works such as the classic command and control and the extended services packages from X73-10201 and X73-20301, respectively, have also been taken into account.

Event-driven, pattern-based methodology for cost-effective development of standardized personal health devices

Experiences applying standards in personal health devices (PHDs) show an inherent trade-off between interoperability and costs (in terms of processing load and development time). Therefore, reducing hardware and software costs as well as time-to-market is crucial for standards adoption. The ISO/IEEE11073 PHD family of standards (also referred to as X73PHD) provides interoperable communication between PHDs and aggregators. Nevertheless, the responsibility of achieving inexpensive implementations of X73PHD in limited resource microcontrollers falls directly on the developer. Hence, the authors previously presented a methodology based on patterns to implement X73-compliant PHDs into devices with low-voltage low-power constraints. That version was based on multitasking, which required additional features and resources. This paper therefore presents an event-driven evolution of the patterns-based methodology for cost-effective development of standardized PHDs. The results of comparing between the two versions showed that the mean values of decrease in memory consumption and cycles of latency are 11.59% and 45.95%, respectively. In addition, several enhancements in terms of cost-effectiveness and development time can be derived from the new version of the methodology. Therefore, the new approach could help in producing cost-effective X73-compliant PHDs, which in turn could foster the adoption of standards.

Research Benefits of Using Interoperability Standards in Remote Command and Control to Implement Personal Health Devices

The initial heterogeneity in the development of Personal Health Devices (PHDs) highlighted the lack of interoperability between agents and managers. The standardization work of the PHD Working Group (PHD-WG) has recently adapted the ISO/IEEE 11073 interoperability standard (X73), initially oriented to clinical environments, to include Personal Health Devices (X73PHD) communications. This new evolution allows the development of interoperable personal health ecosystems. At the moment of this writing, more than 11 specializations have been successfully published by the Personal Health Device (PHD) Working Group (PHD-WG). This new standard brings benefits to both technology producers (design cost reduction, experience sharing, marketing, etc.) and technology consumers (plug-and-play, accessibility, ease to integration, prices, etc.). Nevertheless, some recent specializations at draft stage show the need for a procedure to command and control configuration parameters and settings, which could provide additional benefits such as configurability from the cloud. As a solution, some ad-hoc methods have been elaborated to deal with, although the aim of the PHD-WG is to standardize a general procedure, valid for longer term. Therefore, it is needed to identify use cases requiring remote configuration services. This work identifies and studies new use cases that employ remote configuration services. The resulting use cases, discussed within the PHD-WG to get the maximum consensus, are related to the Basic Electrocardiograph (X73-10406), the Sleep Apnea Breathing Therapy Equipment (X73-10424), and the Medication Monitor (X73-10472) specializations. In addition, a classification of the findings is proposed for each use case. These findings could be the basis for the new remote configuration extension package.

Recent Advances in mHealth: An Update to Personal Health Device Interoperability Based on ISO/IEEE11073

In recent years important advances have been made in the development of health care systems in specific areas owing to different uses and applications. One of the foremost advancements is the so-called mobile Health (mHealth), due to its potential social and economic impact. Within this scope, several technologies – such as smart phones and ultra-slim tablet-PCs, as well as low-voltage and low-power wireless sensor networks – provide telemonitoring services at home and ubiquitous support when they are strongly integrated. Therefore, the integration of international interoperability standards is, nevertheless, required for a regulated transmission of health information in mHealth scenarios. However, such implementation tends to increase the processing load and battery size in order to ensure its autonomy. To tackle this problem, different strategies are being tested in this set of mobile technologies which are aimed at providing a solution to such critical aspects. Another important aspect that should be addressed is the management of communication between different parts that constitutes the system. The new communication capabilities of smart phones enable the implementation of new techniques that improve data transmission from the mobile system to the telemonitoring center, facilitating the integration of Personal Health Devices (PHDs) with telemonitoring systems. This makes the system more accessible to the user.