internet of medical things: technological environment of personalized/ precision medicine
TRANSCRIPT
Internet of Medical Things – Technological Environment of Personalized/Precision Medicine
Alexandre Prozorov, #mHealthLab Laboratory of special medical equipment and technologies of MIPT
29.10.2015, 6-th Moscow Supercomputer Forum
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MIPT IBMP
What is Personalized Medicine?
The first era – FIGHT WITH INFECTIONS, INJURIES AND THEIR CONSEQUENCES Ancient medicine - currently • Development of surgery and therapy. Infections disease control (vaccination)
The second era – FIGHT WITH CHRONIC DISEASE 50 yy. ХХ century - currently • Successful treatment of cardiovascular, cancer and socially significant diseases,
increased focus on the treatment of psychosocial and psychiatric diseases (obesity, alcoholism, drug addiction, smoking, etc)
The third era – THE PRESERVATION AND MAINTENANCE OF HEALTH Currently • Personalized medicine – a new model of organization of medical care, based on the
selection of diagnostic, therapeutic and preventive tools that are optimal for a particular patient, taking into account its genetic, physiological, biochemical, behavioral and other characteristics
• Personalized medicine involves close integration of information technology, science and clinical treatment to achieve the best clinical or preventive results
• Therefore, for the organization of personalized medicine requires close interaction doctor-patient relationship is not only in the clinic but also in everyday life (by analogy with the coaches and athletes)
2 #mHealthLab
Internet of Medical Things (IoMT) What is IoMT? Tasks, logic levels, protokols and architecture of telebiometrics systems
3 #mHealthLab
MIPT IBMP
What is IoMT?
#mHealthLab
Internet of Things
Medical Devices IoMT
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Tasks of IoMT-systems
Each fragments that focuses on acquisi>on and processing of biometric data – is local telebiometrics system, which aims: • To increase the level, resolu>on and compa>bility of bio-‐
quan>fica>on • Using the standardized interna>onal system of
measurement of biosignals • To deploy a standardized encryp>on method from each
node in the collec>on of biometric data to the cloud • To ensure confiden>ality and availability of biometric
data on demand from anywhere
#mHealthLab
On the basis of a coherent technological infrastructure operators of wireless and wired communica>ons grows up the fragments of the global Internet of Medical Things (IoMT)
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Logical levels of IoMT-systems
1. The biological target, is in direct contact with the sensor and exposed to measurement
2. The sensor, is designed to receive (removal rate) of biometric data, including the search for and iden>fy paNerns in the recorded analogue and digital signals. The sensor is integrated into the network infrastructure cloud
3. The Protocol, is intended for preliminary processing and transmission of biometric data to the cloud applica>ons. Its main tasks are interpreta>on, quan>ta>ve comparison and analysis of biological and measurement values of measured data
4. Cloud applica@on, is the recipient biometric data and performs core applica>on tasks according to their recogni>on, visualiza>on, analysis, comparison, recommenda>ons, etc.
5. Cloud storage of biometric data, is intended for accumula>on and long-‐term storage of data, provides the proper level of security, availability and support for different access protocols
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Data Hub
PHR
rSO2
BCG
ECG
Temp
SpO2
MicPatient
Patient Monitoring
Physician
Level 4
Level 1 Level 2
Level 3
Level 5
Potential borders of IoMT-ecosystems (schematically)
#mHealthLab
Categories of telebiometrics applica@ons
Consumer segment
Banking + digital signature
Media + Social networks
Wearable devices
Saving energy + Environmental Monitoring
Physical security
Gaming + Cameras (video / photo)
Automobiles
Avoiding collisions
Driver recogni>on
Voice recogni>on
Medicine and Healthcare
Monitoring of pa>ents in the clinic
Monitoring of pa>ents in the home
Mobile monitoring of health indicators
Tests at home or in the laboratory
Bio-‐banks
Agriculture
Smart farm
Livestock management
Precision agriculture
Monitoring of the epidemiological
situa>on
Aero
Managing the drones
Monitoring of the surrounding space
Fellowship/in-‐flight entertainment (pilot/
passenger)
Legal issues
Registra>on of stay
Registra>on of firearms
Security
Iden>ty management
Surveillance
Physical access control
Monitoring of convicts
Monitoring of popula>ons
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mHealth and IoMT-infrastructure
Preconditions, stakeholders, the notion of medical care, architecture, data flows, technological stack, and features of systems of mHealth
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ЦЖС МФТИ ИМБП РАН
#mHealthLab
mHealth Economic Preconditions
#mHealthLab 9
Preventable complications
Unnecessary procedures
Inefficiency
Mistakes
Positive outcome
30-40% losses
60-70% benefit
Positive outcome 100%
benefit
2020
2015 When the pa@ent is willing to pay?
mHealth stakeholders
#mHealthLab 10
Physician
?
Insurer
?
Patient
?
mHealth
Why?That it (medication,
manipulation, treatment) gives me?
What's going on?How it (medication,
manipulation, treatment) affects of the patient?
What will happen?How it (medication,
manipulation, treatment) will affect health insurance?
Scientist
?
How it works?How it (medication,
manipulation, treatment) works in different conditions?
The concept of medical care in mHealth*
#mHealthLab * According to «mHealth: From Smartphones to Smart Systems» 11
Patient
The convenience and cost reduction in the
treatment (in clinic or at home)
Support of decisions of the doctor
Coordination of treatment or rehabilitation
Involve patients in the process of treatment
or rehabilitationManagement of a course of treatment (rehabilitation)
Management of monitoring of
patientsPrevention and rehabilitation
Hospitalization, ambulance or high-tech medical aid
Personal communications
Remote monitoring
Diagnosis
Training courses and coaching
Representation of interests
(for the insured, employee, etc.)
Factual information about the patient's
condition
Data flow to PHR/EHR
Devices
Infrastructure
The business models of the mHealth-operator
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Business model of mHealth
Service level Variants Comments
BRANDED SERVICE
L7 В2С Direct info-‐medical services to clients
L6 В2С2B Direct informa>on and communica>on monitoring services, exper>se through partners
BRANDED PLATFORM
L5 В2В2С PHR plalorm + own IoMT devices and applica>ons. All services through partners
L4 В2В PHR plalorm ("engine") for service providers
CONNECTIVITY
L3 В2В2С Aggrega>on of services of various service providers of IoMT -‐ a market плейс + tariffs + billing
L2 В2С Provision of basic communica>on services for health monitoring services
L1 В2В Provision of basic communica>on services for medical ins>tu>ons
#mHealthLab 13
# mHealth Applications Variants Benefits 1 Control of chronic diseases Wearable monitors Anticipatory manipulations
2 Observance of a course of treatment
Reminders and alarms by means of messages, email, mobile applications
Increase patient satisfaction
3 Remote patient monitoring System of tracking of location and safety of the patient
Reducing the cost of treatment
4 Access to health information Electronic health records (PHR/EHR)
Moving to a nursing home without loss of medical information
5 Interactions between physicians and other medical personnel
Social networks, based on the Web
The increased share of self-government
6 Individual program for rehabilitation and fitness
System for monitoring diet, physical activity, quality of life, based on Web technologies
• Improvement of health and rehabilitation • The increased quality of life • Reducing the burden on family members and health care
staff • Better interaction between doctor, patient, family and staff
for better care
mHealth: examples of applications and their results
The architecture of mHealth systems (schematically)
#mHealthLab 14
100% mobility
In clinic or home
IoMT-frontend
IoMT-backend
IoMT applications M2M networks IoMT devices
App Backend
BioData Storage
HL7 Gateway
Patients monitoring
Courses of treatment
Сhronic diseases
Physician
Scientist
Rehabilitation and fitness
Corporate Social nets
PHR/EHR
Data hub
Smartphone
Patient
Patient
Satellite segment
Mobile segment
Wired and wireless
segmentsWBAN
- IEEE 802.15.6- ZigBee / IEEE 802.15.4- Bluetooth, Bluetooth LE- Wireless USB- Proprietary solutions (ANT, Sensium, Zarlink, Z-Wave)
Access networks- GSM, UMTS- LTE, LTE-A- WiMAX- WLAN- Satellite
Insurer
Patient
The data flows of mHealth systems
#mHealthLab 15
Patient
WBAN M2M net mHealth operator Clinic
Cloud solution
Diet and lifestyle
Fitness
PHR Physician
Hospital Information System
Patient monitoring
Courses of treatment
Management of chronic
diseases
Rehabilitation
EHRImplantable
medical devices
On-body (tattoo, sticker) medical
devices
Wearable medical devices
Stationary medical devices
Data hub
Scientist
Patient
Insurer
Technological stack of mHealth systems (tasks)
#mHealthLab 16
Core Network
IoMT
IoMT Device
Sensor
Primary signal processing
WBAN transmitter
IoMT Data Hub
WBAN receiver
Semantic signal processing
M2M transmitter
M2M net
WLAN/ Ethernet/ PSTN/ Cellular/
etc
QoS for realtime IoMT traffic
mHealth Operator
IoT Middleware
M2M receiver
Decoding and data aggregation
Moving data on storage
IoMT Platform
Long term data retention
The search for patterns and
generate events
Providing data on demand
Clinic
IHE Components
Integration to mHealth operator
cloud
EHR
Modellind and Machine Learning
ModellingPlatform
Machine Learning Tools
Analitycs
Analitycs Platform
Visualization Tools
Technological stack of mHealth systems (solutions)
#mHealthLab
Hadrware IoT Middleware IHE Components
Modelling and ML Tools
Analitycs and Visualuzation
HW (inc. WBAN)
Hardware platform:- Renesas- Texas Instrumets- Microchip- STM- Arduino (Amtel)- Raspberry, etc
Transport wireless protocols:- IEEE 802.15.6- ZigBee / IEEE 802.15.4- Bluetooth, Bluetooth LE- etc
Middleware and Platforms
IoT Middleware:- OpenRemote- OpenHAB- iotsys, etc
IoMT Platforms:- MS HealthVault- Google Health- Qualcomm Life 2net, etc
M2M Protocols
App. Level Protocols
Encoding:- CSV, JSON, XML- BSON, Message Pack- Protocols Buffers
M2M communications:- MQTT - MQTT-SN- AMQP- CoAP- HTTP
Platforms
Interoperability:- Mirth Connect- eTransX- HL7 Interface Engine, etc
EHR:- OpenEMR- FreeMED- OpenMRS, etc
Frameworks and Platforms
ML Frameworks:- scikit-learn- shogun- MLlib, etc
Platforms:- R + RStudio- Matlab- Spark, etc
Libraries and Platforms
Charting libraries:- D3.js- Chart.js- Highchart.js, etc
Analitycs Platforms:- Tableau- QlikView- Omniscope, etc
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Specifics of IoMT-devices
#mHealthLab
Many IoT devices generate personal data, protected by 152 Federal Low. However, with IoMT devices is much more complicated: • IoMT-‐medical devices generate data that is most sensi>ve to
compromise
• Breaking and unauthorized use of IoT-‐devices can lead to death or problems with health of the owner
• Interest of malefactors in blackmail and extor>on by means of a compromise of IoMT-‐devices with high probability in the long term will lead through 3-‐5 years to the "black" market of the corresponding criminal services (by analogy with the botnets market)
• FSB is necessary with coordina>on to the interna>onal ins>tutes of standardiza>on as soon as possible to begin work on standardise and cer>fica>on of reliable mechanisms of protec>on of the IoMT-‐devices applicable in the territory of the Russian Federa>on Nanoribbon Heart Implant
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MedCore – medical grade stickers and non-contact IoMT-devices Solvable problems, nomenclature and options for the use of IoMT-devices, the variants of mHealth systems architecture
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ЦЖС МФТИ ИМБП РАН
#mHealthLab
Solvable problems
#mHealthLab
MedCore is an integrated set of IoMT-‐devices and complementary sotware to build complex medical or telebiometrics solu>ons in the following areas:
• Medicine (treatment of chronic pa>ents, monitoring of pa>ents…)
• Rehabilita>on (the care of newborn infants, bedridden pa>ents…)
• Sports and fitness (tracking indicators, the >ming of the training…)
• Healthy lifestyle (the >ming of the sleep, control snoring…)
• Intensive produc>on processes (health monitoring operators, managers, fighters…)
MedCore aimed to comprehensive solu>on of problems of biometric monitoring of health indicators in real-‐>me and >mekeeping of the human condi>on with medical precision
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#mHealthLab 21
# IoMT-device/ software The principle of operation Logic level
1 Non-contact BCG-sensor Mechanical vibrations of a fragment of a body placed over the sensor
Sensor
2 Sensor-sticker single-channel ECG Fluctuations of the electric potential taken with the skin in the chest area
Sensor
3 Sensor-sticker wideband microphone Sound vibrations taken from the skin in the chest or abdomen
Sensor
4 Sensor-clip SpO2 The fluctuations of transparent ability of skin measured in area of fingers, an auricle
Sensor
5 Sensor-sticker body temperature The skin temperature at the chest, abdomen Sensor
6 Sensor-sticker movement and body position (3D)
Mechanical oscillations and the position of the chest, abdomen, back, arms and legs
Sensor
7 Data hub (device) Acquisition biometric data from sensors, filtering and semantic analysis of data and transfer clear data to the cloud
Protocol
8 API for smartphone (Android, IOS) Acquisition biometric data from sensors, filtering and semantic analysis of biometric data
Protocol
9 API for cloud solutions (Linux, Windows) Acquisition biometric data from data hubs and smartphones Protocol
MedCore: the range of devices and software
#mHealthLab 22
# IoMT device Usage scenario
1 Non-contact BCG-sensor • Chronometry of sleep • Chronometry of bed rest • Registration apnea • Registration of seizures • Measurement of basic vital indicators of the person in a lying position • Measurement of stress and fatigue the operator (driver, pilot, etc.) in a sitting position
2 Sensor-sticker single-channel ECG
• Cardiac monitoring during the day • Cascadable for multi-channel devices record ECG including Holter monitoring • Measurement of stress and fatigue the operator (driver, pilot, etc.) in a mobile position
3 Sensor-sticker wideband microphone
• Listening to the fetal heart (for pregnant women) • The definition of extraneous noise during breathing • Determination of the respiration rate during the day • Determination of the intensity of environmental noise
4 Sensor-clip SpO2 • Determination of hemoglobin saturation of arterial blood
5 Sensor-sticker body temperature
• Definition of body temperature
6 Sensor-sticker movement and body position
• Determining the position of a body • Determining movement of the body • Cascading devices for registering 3D-BCG
7-9 Data hub, API • The collection of bio data from the sensors, data transmission in IoT-Middleware or mHealth-cloud • Semantic processing of «raw» bio data
MedCore: options for using devices and software
Creation of mHealth-system on the basis of Open mHealth (schematically)
#mHealthLab 23
Phar macy
Inven tory
ETL
EHR
REST
Mobile
HL7 GATE
WEB
HIS
3D
Data Hub
BCG
ECG
Temp
IoMT devices M2M net Clinic
SpO2 IT-systemsof clinic
Open mHealth componentsMedCore
devices
The devices used in the clinic or at
home
Creation of the IoTM-system based on OpenHAB (schematically)
#mHealthLab 24
xPL
KNX
Add-ons
Core
REST
Mobile
Event Bus
WEB
VSCP
3D
Data Hub
BCG
ECG
Temp
IoMT Devices M2M net OpenHABCloud
SpO2 The OpenHAB components for integration from Smart-devices
(locally in the house)MedCore components
Mic
Smart phone
Persis tence
Event Bus
OpenHAB smart Interfaces
RS- 232
The OpenHAB components in a
public cloud
The devices used in the bedroom
The devices used during sport
activities
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PROZOROV Alexandre
Research associate of Laboratory of special medical equipment and technologies of MIPT
Research associate of the Innovative center of space medicine of IMBP Russian Academy of Sciences
CEO of "Mobile Health Lab”
Email: [email protected]
Mobi: +7 916 9989619
Have questions? Ask!
#mHealthLab