ASIA-PACIFIC TELECOMMUNITY
2nd APT/ITU Conformance and Interoperability Workshop
(C&I-2)
26 August 2014, Bangkok, Thailand
Document:
C&I-2/ INP-02
22 August 2014
Affordable and Collaborative
BAN Portable Health Clinic
Contact :
Masahiro Kuroda
National Institute of Information and
Communications Technology, Japan
Email: marsh@nict.go.jp
Affordable and Collaborative
BAN Portable Health Clinic
Masahiro Kuroda
National Institute of Information and
Communications Technology, Japan
marsh@nict.go.jp
1
Health: Benefit to Personal & Public Health
‐ N
Nearly
l 80% of
f NCD deaths
d
h (29 million)
ll )
occur in low- and middle-income
countries and lead to catastrophic
medical expenditures
Global
l b l NCD deaths
d
h under
d age
70 by cause of death, 2008
‐ More than 9 million of all deaths
attributed to NCDs occur before the
age of 60; 90% of these "premature"
deaths occurred in low- and middleincome countries
‐ Affordable e-health for public health
keeps healthy workers and national
interest
NCDs: Non Communicable Diseases
2
Relative Costs of Poor Health:
T t lV
Total
Value
l of
f Health
H lth
Direct Costs: Medical & Pharmacy
y
Indirect Costs:
Worker s compensation
Worker’s
Absenteeism: A habitual
Long-term Disability
pattern of absence from a duty
Short-term Disability
Presenteeism: An act of attending work while sick
Time-Away-from-Work
m
y f m
Edington, Burton. A Practical Approach to Occupational and Environmental Medicine (McCunney). 140-152. 2003
3
Health Spending Out of Pocket
Out of pocket expenditure is any direct outlay by households to health
practitioners and suppliers
p
pp
of pharmaceuticals,
p
therapeutic
p
appliances,
pp
and other
goods and services. http://data.worldbank.org/indicator/SH.XPD.OOPC.ZS)
120
100
80
60
40
20
Private spending on
health as % of all
health spending
Health spending out of
pocket, as % of all
health spending
Doctors, per 10,000
population
0
4
Affordable Public Health keeps National
I t
Interest
t
•
E id i of
Epidemic
f Ob
Obesity
it C
Communicable
i bl ?
– Yes and No
•
•
Alcohol abuse cost the U.S.
. . health care system
y
m $85.8
$ . billion in
1988. The tab for cigarette smoking totals over $65 billion
annually. Costs related to obesity now surpass $27 billion per
year.
year
The American Medical Association recently revealed that at
least 25 cents of every health care dollar is spent on the
t
treatment
t
t of
f di
diseases or di
disabilities
biliti that
th t result
lt from
f
potentially
t ti ll
changeable behaviors.
http://www.scu.edu/ethics/publications/iie/v6n1/voluntary.html
5
BAN in BAN Portable Health Clinic
•
Body Area Network (BAN) offers a wired communication or
short range radio communication capability for sensors to
exchange data with a gateway around a person
person’ss body (From
ITU-T Focus Group on M2M service layer: M2M enabled
ecosystems: e-health )
•
BAN is not limited to the space around a person
person, but depends
on the distance reachable by cables and radios
“O
“Overview
i
of
f key
k functional
f
ti
l components
t in
i the
th e-health
h lth ecosystem
t
f
for R
Remote
t patient
ti t monitoring/assisted
it i / i t d li
living”
i ”f
from ITU
ITU-T
T M2M FG reportt
6
BAN and Medical BAN Technologies
BAN
Medical frequency band for quality of service
Low-power consumption in modulations
Strict security enforcement
Top-priority
Top
priority data transfer for emergency data
Ensure secure SAR (Specific Absorption Ratio) level
Medical BAN
IEEE802.15.6
IEEE802.15.4j(US only)
IEEE802 15 4n(China only)
IEEE802.15.4n(China
ISO/IEC14443
FeliCa
7
Affordable Checkup and Telemedicine
•
•
BAN Portable Health Clinic (BAN-PHC): Health check-up and
telemedicine
m
on sites,, such as factories
f
in urban areas and
villages in rural areas
Continuous use in areas where power supply is unstable , easyto-use
to
use interfaces to users, such as paramedics, easy network
maintenance and ease of carrying
BAN- PHC
BAN weight meter
BAN pulse oximeter
BAN sphygmomanometer
BAN waist meter
BAN body temperature
& Blood glucose meter
An international joint-research project "portable health clinic“ : Kyushu university hospital, Graduate school of IS and EE, and
Grameen Communications. NICT cooperation: Provide low-power & secure BAN standard technologies both for medical/healthcare
devices and for the coordinator based on Android
8
Real Technologies for BAN
BAN-PHC
PHC
•
•
•
•
Under unstable power supply and
batteries may not be charged
Data transfer via cell phone may
not be available
Li it d space/location
Limited
/l
ti iin setting
tti
up the clinic
User-friendly interface for
examiners
Rural
u
case
Disaster case
Mass Medical Exam. case
Tokyo, Japan, 4‐5 February
2013
9
BAN-PHC System
y
R
Remote
medical
di l h
help
l center
Remote database
Point-of-care
f
medical examination,,
categorization, and telemedicine
B-Logic
Examinees
3. Remote diagnosis and prescription
Blood pressure,
blood, urine, etc.
M di l certificate
tifi t and
d prescription
i ti
4 Medical
4.
2. Use measurement devices for automatic categorization
1 Bring-in
1.
B i i BAN
BAN-PHC
PHC
Non-invasive medical BAN devices
Blood test
U i l sis
Urinalysis
10
Role: doctor,
coordinator,
local assistant,
assistant
nurse, female
support,
paramedic …
Vital Data
1 Registration
1.
Registration, interview
informed consent
Clinical Data Conversation Data
Triage
Database
Healthcare
Guideline
Presc
cription D
Data
BAN-PHC
BAN
PHC Workflow
Triage
2. Health
checkup
3. Tele
Consultancy
4. Prescription
& Suggestion
11
B-Logic:
B
Logic Automatic Categorization
Green
Yellow
Orange
Blood Pressure
(mmHg)
<140 mmHg
<90 mmHg
140≦ <160 mmHg 160≦
90≦ <100 mmHg 100≦
Blood Sugar
<100mg/dl
100≦ <126mg/dl
126≦ < 200mg/dl
≧200mg/dl
<140mg/dl
140
/dl
140≦ <200mg/dl
200
/dl
200≦ < 300mg/dl
300
/dl
≧300mg/dl
300
/dl
≧96%
93≦
90≦
<90%
Postprandial Blood
Sugar
Urine test
<180
<110
Red
180≦
110≦
…
SpO2
<96%
<93%
Red: Emergent -Telemedicine + Encouragement to visit clinic
Orange: Affected -Telemedicine
Yellow: Caution
-Provide
a leaflet about health care in Bengal
Green: Normal
Designed by Naoki Nakashima, M.D., Kyushu University Hospital and
Kunihisa Kobayashi, M.D., Fukuoka University Chikushi Hospital
12
Population Management of Chronic Diseases
BAN Portable Health Clinic
Health checkup by a sensor set
Stratification and health guidance by leaflet
Primary
P
Prevention
ti
Healthcare Field
healthy
caution
sick
emergent
extraction
Telemedicine ((Tele-mentoring,
g, tele-prescription)
p
p
)
Secondary
Prevention
Push to
Clinics
Medical treatment
（Local healthcare center）
Continuous Telemedicine
Tertiary
Prevention
Innovation by ICT
From Dr. Naoki Nakashima, Kyusyu University Hospital
13
BAN-PHC
B
N H Devices
D c s on Site
St
•
•
Support International BAN Standards
Plug-in
Plug
in any sensors following the open standards
Android terminal + BAN
BAN blood pressure with IHB*
BAN p
pulse oximeter
m
BAN waist/hip meter
BAN blood
glucose meter
BAN height meter
BAN contactless body
t
temperature
t
meter
t
BAN weight meter
*IHB: Irregular Heat Beat
14
Android
ndro d Tablet
ablet Screen in
nB
BAN-PHC
N H
15
Medical Checkup and Remote Diagnosis in
R
Rural
lA
Area, B
Bangladesh
l d sh
Woman doctor
for Women
examinees
D t ’ remote
Doctor’s
t exam.
R
Remote
t examinee
i
W
Wait
for
f remote
Start
Physical examination scene
Measured data on android tablet
Reg. , Interview Informed consent
16
Results of Ｔelemedicine in FY2013
Visitors n=7794
Telemedicine
T
l m di in
(n=3080)
(2nd
Ask to visit
2months later
Emergent(14%)
At the first
visit
n=709
Emergent(5%)
Affected(35%)
2nd visitors, n=709
health check up is not finished)
Healthy(9%)
Affected(86%)
n=7794
2month later
Caution(51%)
Emergent(9%)
g
Healthcare
instruction
Healthy(5%)
n=709 Caution
(45%)
Affected (40%)
*Orange was increased in FY2013
because B-Logic was revised。
Progress report in FY2013
※We have to think “regression to the mean”
From Dr.
Dr Naoki Nakashima
Nakashima, Kyusyu University Hospital
17
Collaborative BAN
BAN-PHC
PHC
•
•
Any device following open standard interfaces and formats can
be a m
medical/measurement
ca /m asur m nt device
c in
n BAN-PHC
N H
Cost effective device gets the position in BAN-PHC
Medical device A by different manufacturer
Open
p and international standard BAN
Medical device B
Bio device C
Medical/Non-medical devices D
18
Standards around E-Health and Medical BAN
e‐Health Application Examples
Surveillance
HIMSS
Telemedicine
ISO/
TC 215
GS1
Electronic health
record reference
Health monitoring
& reporting
Intervention
management
Assisted living
IHE
DICOM
IHTSDO
HL7
ITU‐T
SG16
MBAN
Health information
Healthcare ICT
GSMA
CDISC
epSOS
ITU‐T
FG‐M2M
CEN/
TC 251
Continua
BT
Medical/Healthcare device
MBAN (Medical Body Area Network) international standards
are essential for qualified eHealth.





Medical frequency band for quality of service
Low-power consumption in modulations
St i t security
Strict
it enforcement
f
t
Top-priority data transfer for emergency data
Ensure secure SAR (Specific Absorption Ratio)
level
 IEEE802.15.6 Narrow Band [US,JP,EU,
400MHz, 800MHz, 900MHz, 2.36GHz,
2 4GH ]
2.4GHz]
 IEEE802.15.4j [US, 2.36GHz]
 IEEE802.15.4n [CN, 200MHz, 400MHz,
600MHz] Coming up soon
19
Example: Japan and China worked on
common Medical
M di l BAN standards
t d d
“Off-the-shelf” Android tablet
Various devices
BAN
International standards but depends on radio regulations in each country
(1)IEEE802.15.6(US,EU,Japan,China)
(2)IEEE802.15.4j(US)
(3)IEEE802 15 4 (Chi )
(3)IEEE802.15.4n(China)
Japan, China and US worked together on common BAN
standards between IEEE802.15.6 and IEEE802.15.4n
20
Ready for Affordable BAN-PHC
b
business
model
d l
Dr. Muhammad Yunus,
a Bangladeshi
B
l d hi banker
b k
M di l d
Medical
doctors
t
and Nobel Peace Prize
recipient, inspects the
PORTABLE HEALTH CLINIC
first portable health
Affordable healthcare for unreached
clinic.
and aging community
Healthcare
Service
BAN-PHC
Global Social Business Summit 2013
7-9 Nov. in Malaysia
http://www.gsbs2013.com/home.html
2
3
Rural/Urban
Patients
Portable
Health Clinic
1
4
System maintenance service
Village
Healthcare Lady
New Social
Business
Venture
Micro entrepreneurs
Microfinance
Bangladesh
Prime
P
i
Minister
Mi i t off
Malaysia
PHC supported by 最先端研究開発⽀援プログラム「超巨⼤データベース時代に向けた最⾼速データ
ベー スエンジンの開発と当該エンジンを核とする戦略的社会サービスの実証・評価」
Use at evacuation site
in disaster‐
disaster‐stricken area
21
BAN-PHC
BAN
PHC Demonstration
Android terminal + BAN
BAN blood p
pressure with IHB*
BAN pulse oximeter
BAN waist/hip meter
BAN blood
glucose meter
BAN compact
weight meter
BAN
B
N contactless
l
body
b d
temperature meter
22
Evolving BAN
BAN-PHC
PHC
Health checkup and telemedicine
Link between
b t
n a us
user and
nd his/her
his/h data
d t
BAN blood pressure with IHB
BAN vein authentication
BAN pulse oximeter
Compact wireless
A6 printer
BAN blood
sugar meter
Infection prevention
Android terminal + BAN
BAN non-invasive blood
hemoglobin measurement sensor
BAN waist/hip meter
BAN scale
BAN contactless body
temperature meter
23
Conclusion
•
•
•
Start to provide affordable health checks and telemedicine in a
attache case suitable for primary health care to BOP/MOP*
Ready to provide interfaces to integrate devices for BAN-PHC
Trigger reverse innovation for affordable and collaborative
BAN-PHC business model using open and international standards
MOP
BOP
To reverse innovation
*BOP: Base of the Pyramid
*MOP: Middle of the Pyramid
24