Comparison of Pervasive Home based Health Care Systems
under E-Health Perspectives
Zeinab Abbasi Khalifehlou
Department of Computer
Engineering, Shabestar Branch,
Islamic Azad University
Farhad Soleimanian
Gharehchopogh
Shabestar, Iran
Department of Computer
Engineering, Hacettepe University
Ankara, Turkey
Tabriz.ce@gmail.com
Bonab.farhad@gmail.com
ABSTRACT
Today’s, advanced Information and Communication
Technologies (ICT) impress all of health perspectives. One of
the human processes is body health and using e-health to help
the health of individuals in human societies. ICT has high
performance to support patients increasingly by means of new
modern methods such as Multi Agent Systems (MASs). The
agent based systems present new techniques to resolve human
problems and implementing of them with software systems. In
this paper, we introduce non-critical systems. The main
characteristic of these systems are empathic on the remote
healthcare as pervasively. We evaluate mobile multi agent
based distributed information platforms for pervasive home
healthcare monitoring as well as e-health security mechanisms
in Java Agent Development Environment (JADE). Finally, we
discuss about implemented e-health systems in Iran and their
executive processes currently.
Keywords
E-Health, Health Care, Multi Agent Systems, Security
Mechanisms, Information Technology.
INTRODUCTION
Nowadays, with advances in science and technology, it has
been new methods to solve complex problems that face to
human health based on electronically medical systems. In the
recent years, pay more attentions to create and using these
systems to patient’s treatment. MASs is new modern method to
implement efficient medical systems. MASs are extremely
important to generating medical health care systems
electronically because of unique features e.g. parallel
operations, ability to collect data from environments in real
time processing automatically and autonomously and etc [1].
These systems are designed to improve lives of peoples,
creating simple and impressive ways to prevent an emergency
situation in treated patients [2]. As this regard, effective usage
of communication technologies to enhance public health and
patient’s treatment is too notable.
In order to electronically medical improvements, it has been
considered e-health which means internet based support of
various types of medical information, products, technologies
and medical services [3, 4]. Using intelligent agents as an
efficient manner to increase the performance of automated
medical systems in the field of information technology with
features such as scalability, reliability, ability to it
reconfiguration, autonomously functions and etc. among of
other characteristics of active agents in medical care, support
synchronous/asynchronous
form
of
communication
technologies and cooperation with each other, implementation
of medical services based on patient needs, increasing control
medical records by physicians are significant.
The role of internet in agents based systems [5, 6], wireless
sensor networks [7, 8], mobile services and other
communication services is greatly notable. Wireless sensor
networks have many applications in medical health care,
emergency cases, security, industrial automation, earthquake
detection and astronautics and many more. Medical
information and communication systems collect information in
the field of medical care, clinical messaging, engage nurses,
medical records, and benefit of them called telemedicine.
Telemedicine refer to using telecommunication and
information technologies to supply clinical health care at a
distance and in time [9] are classified into three main parts are
store and forward, remote monitoring and interactive services.
In the home based health care systems, systems try to track and
focus on in-home care operations such as designing monitoring
systems, emergency alarms and etc. thus with designing and
generating electronically medical systems many problems and
issues to be solved within in time and without an place and time
restrictions.
This papers deals with home e-health care systems based on
MASs. The rest of the paper is organized as follows. We
introduce to e-health principles and aims and scopes of medical
systems electronically. Then, we consider the MASs, previous
related works and applications of them in the medical domain.
Another section is discussion about home based health care
systems which implemented electronically. In the subsection of
this section, we evaluate and review the home based healthcare
systems and so we reviewed discussion and the conclusion of
this paper.
E-HEALTH
E-Health is new emerging science of combining medical
informatics, public health which will be promoted through the
internet and related technologies [10]. The term e-health or
electronic health is the electronic health means different
interpretations and meanings are in the IT fields. E-health can
sense the use of electronic technology in the health, medical
care, public health and etc. using e-health technologies in
medicine and telemedicine [11] in order to practice medicine,
public health and medical care of people in human society [3].
By means of electronic ICT in the health sector, everything
from transfer digital data from purchase orders, reports,
laboratory tests, medical history and insurance premium is
possible with internet based platforms such as JAVA Agent
Development Environment (JADE) [9]. In the other hand, ehealth, health-related exchanges of electronically medical
records that can be performed via different organizations,
although a physician or health care constitute their different
paths [10, 12] such as care of people with diabetes [13] or
Alzheimer’s [14] disease and so on.
Many examples of the successful of implementations of an
electronic health information network that contain electronic
medical records (EMR), telecom services, medical monitoring
systems such as [15, 16, and 17], mobile medical portals and
etc [11]. It is mentioned that medical care can be provided in
health centers, applied health services to increasing awareness
by informing the public e-health via audio and visual media
services for specialized medical testing, periodically check-ups
to ensure the health, e-health books and so on.
MULTI AGENT SYSTEMS
Agent is a computer program that is able to perform automatic
and independent functions from its owner or user. The main
feature about the agent is their autonomy and they able to act
independently and have control over their internal states [1, 18
and 19]. MASs are new methods for solving and
implementation computerized software systems in which the
agents is collection of software classes factually. These agents
can be received data from different parts of the system
autonomously and asynchronously as well as decide about
them. Decision procedures in the agent based systems are by
means of the data mining and machine learning algorithms
[11]. The agents have many applications within high
performance in the wide areas of medical that can be able to
transfer distributed information such as case history as EMR in
the hospitals, clinics, surgery centers in order to achieve
remedy and treatment [15].
In recent years, many studies have been done in this scope. For
instance, Haigh et al, [20] presented an open agent architecture
for assisting elder independence which is a MASs that
incorporates a unified sensing model, probabilistically derived
situation awareness, hierarchical task network response
planning. The proposed model act as real-time selection
control, complex coordination within machine learning
techniques to decision support. Daknou et al [21] proposed a
tool to assist decision-making process for medical care of
patients at the emergency departments within rapid access to
patient medical records, integration of care’s protocols and
assure knowledge of the quantity and the quality of medical
activities. Su and Wu [11] presented JADE implemented agent
based platform for pervasive medical care monitoring which is
able to aware the responsible care, provider of abnormality
automatically, offer distance medical advice and perform
continuous health monitoring and reduce caregiver burden. The
proposed system composed of six agents which are user agent,
source agent, physician agent, diagnostic agent, knowledge
based data server agent, external services agent e.g. vital sign
monitor. As a result, this system is able relieve hospital
personal from time consuming task of constant data monitoring
and also able to provide patients a mobile, ubiquitous and
personalized e- health care.
Home based health care systems
Health care implicate to the all kinds of activities for disease
presentation, treatment and recovery processes. The medical
and health activities by various medical organizations,
academic institutions and other professionals to raise
awareness, diagnosis and treatment are in [2, 3, 9, 11 and 15].
Medical care systems in homes or home based medical care
systems are based on MASs in order to design monitoring
systems as distributed are applied with alarm in emergency
times. These systems emphasize to care of patients at their
homes. At these types of systems, socio-medical care has been
considered [13].
Improvement in patient care through the management of
distributed software using smart agents, remote medical care
for the elderly or chronically ill in the hospital is possible by
monitoring and collecting, compiling and organizing medical
knowledge available on the internet [3]. In the follows, we
compare and evaluate four agent based medical systems with
home approach to care and assist of patients at home with great
potential to transform the process, and possibly even the
outcomes. The systems are Tele-monitoring of patients at home
with software agent approach [15], home care system [18],
monitoring Alzheimer patients [2], and heart failure
management in a home care environments [22] are detailed as
follows:
A.
Home based Tele-monitoring of patients
System
Agent based Tele-monitoring system is a part of a great
research project on Health Smart homes (HSH) to care of
patient remotely in the clinical centers at the Grenoble in
France [15]. Smart home system for health care of patient at
smart homes is shown in the fig 1:
Fig. 1. Smart Home in the Tele-monitoring of Patients
[15]
Designing and creation of this medical system remotely
possible in two network levels: home level and community
level. Agents applied in this system are explained in the
Table1.
TABLE 1: AGENTS IN the TELEMONITORING
SYSTEM
Agent Name
Sensor Agent
MeDiv Agent
Device
Sensor
medical
devices
LAN-Agent
Local Area
Network
Home
Computer
Home Server
Agent
Scenario
Recognizer
Agent
Main Server
Agent
Client Agent
Remote server
Careers'
access
Activities
Calculating output data
from physical sensors
and local parameters
such as transformation
rates and formats
Network and Sensor
messages management
Analysis of data to
decision making, alarm
and saving local
information
Data warehousing, user
management and
machine learning
Tele-monitoring,
response to alarms,
access to database and
processing personal
data
--Directory Agent: It manages services list can be used by
system.
--Supervisor Agent: It monitors to proper functions in the
system.
--Security Agent: It analysis and evaluate the structure of
inputs and outputs XML messages.
--Manager Agent: This decides about which agent should be
called in the user account.
--Interface Agent: This agent designed to be into the user
application programs.
C. MONITORING ALZHEIMER PATIENT SYSTEM
Alzheimer’s is a brain disease that affects many people in
their old age. This disease with dementia in along with time in
beginning and gradually becomes more and more. Various
types of home based systems to assist of Alzheimer’s patients
such as AlZ-MAS [14] and OVAMAH [8]. The structure of the
applied agents in the organization model of this medical system
is shown in the fig3.
B. HOME CARE SYSTEM
The terms Home Care (HoCa) [18] refer to all kind of own care
in the home environment. The services of the presented system
in the home have been performed by combining intelligent
agents, identification and localization of technology, wireless
networks and mobile devices.
The architecture of the home care system is shown in the fig 2.
Fig3. Structure of Alzheimer’s patient care system [2]
ALZ-MAS structure has five agents which each of them have
special roles. The problem needs include patient personal
information and their manner (monitoring, place, daily tasks
and abnormalities), physicians that treat the patients and nurse
program and etc with detailed in [2].
D. HEART FAILURE MANAGEMENT SYSTEM
Fig2. Home Care System Architecture [18]
The architecture of the proposed system composed of agents
which are CoAp, CoSe, Directory, supervisor, Security,
Manager and Interface agents which described as:
--CoAp Agent: It is responsible to all of communication
between application programs and framework.
--CoSe Agent: this is responsible to all of communication
between services and software platform.
Today, heart Failure (HF) is the most common cause of death
in the world. Management costs include hospitalization,
outpatient surgery costs and visiting HF patients are too high.
The main aim of MASs is home based care from patients with
HF, controlling their health conditions, monitoring and
educational services to the chronic patients via
communicational software platforms in order to manage HF
diseases. The proposed system [22] uses home care
telemedicine system and calling with medical centers perform
care of patients. The architecture of agent based HF
management system is shown in the figure 4.
systems can be used in the real environments with critical
performances. The java security model based system provides
the following benefits to MASs [19]:
--Java Authentication and Authorization Service (JAAS): that
identifies permissions for operations on a predetermined set of
classes, libraries and objects.
--Java Cryptography Extension (JCE): implements set of
functions that allow to the developer to create and manage key
and uses encryption algorithms.
fig 4. Heart Failure Management System Architecture [22]
The main tasks of agents in the heart failure management
system consist of [22]:
--Access to medical information, monitoring patient’s
condition in real-time
--Processing of medical information and interpreting patient
data
--Reasoning, processing methods in order to evaluate the
results
--Communicating between agents for collaboration and
knowledge sharing
--Negotiating for specific operating decisions and assessing the
results obtained from production and general information about
the patient’s condition
--Learning methods to increase the capabilities and efficiency
of the system of reasoning agents.
SECURITY MECHANISMS IN EHEALTH SYSTEMS
JADE platform [9] uses JADE-S security methods to providing
safety and trusted communications between agents’
interactions. In order to find out the role of information security
in critical information transformation (which deals with the
lives of peoples) in the following three concepts is essential to
redefine [19]:
--Confidentiality: ensure that only those who are permitted to
have access to information.
--Integrity: ensure that data cannot be changed; these changes
include adding, deleting and removing the palace of data.
--Authentication: refers to ID that is a link between information
and its sender.
--Non- repudiation: it prevents the negative parts of some
previous commitments or actions of agents.
Because of autonomously agents, these characteristics are
important and critical in design on agent based systems in
medical domains. The agent based systems without any
security mechanisms cannot be used in an open environment
like internet. When critical medical data are transferred via
internet, if they don’t comply, agents simply fail in their data
communications and authentications. JADE-S is a plug-in of
JADE that allow to creating some of security features to the
agent based system in the development time. Thus, these
--Java Secure Socket Extension (JSSE): that allow to changing
in the critical information in the network by means of secure
data transmission (SSL) protocol.
DISCUSSION
Until the last years, medical records of patients have been
completed by physicians and medical teams, but today’s, the
creation of electronic health records is accessible to all doctors
have a functional plan in some hospitals in the number of
regions in Iran. Electronic prescription and taking online visit
times are other functional plans to increasing public health and
human being in the society and preventing losses of time, and
high performance in medical services in the least possible time.
These are impossible in the past without digital and
communication technologies. With creation these approaches
in the internet based platforms; we can prevent the results of
incorrect diagnosis of outpatients or chronically patients or
even peoples need to prompt diagnosis or surgery.
Also, these systems help to preventing the dangerous
consequences of the damage that can be with life and health
care handled. They help eliminate distance barriers and can
improve access to medical services that would often not be
consistently available in distant rural communities [19]. They
are also applied to support lives in emergency times and critical
care. These technologies permit communications between
patient and medical staff with both convenience and fidelity, as
well as the medical transformation, imaging and health
informatics and data from one site to clients and vice versa.
Agents due to the unique operating characteristics of the
discovery, extraction, interpretation and verification of data led
to increasing efficiency, flexibility and simplicity of systems
are designed. Electronic medical systems are able to implement
in the various software platforms in which they have ability to
agent based software creation. These systems depend on the
application type categorize in the non-critical systems. The
home based health care systems as mentioned above located in
the non-critical systems. Using data mining techniques [24]
like artificial neural networks, Case Base Reasoning, Decision
Tress, Bayesian Networks and etc. are very extremely and
greatly significant in order to analysis, interpret and critical
decision making in the hospitals, clinics and emergency
departments.
As a result, we recommend to increasing scalability of home
based health care systems over national and international levels
as well as real-time control of operations in the medical internet
based systems as well as using encryption protocols to
encrypting transferring data and SSL to ensure that the secure
communications.
CONCLUSION
Recent developments in the 20th century led to the use of
mobile technologies in the area of agent-based systems and the
application of these systems in medical domain to helping
medical care and treatment through ICT is extremely have been
received in modern medical societies. Medical care systems in
homes or home based medical care systems are based on MASs
in order to design monitoring systems as distributed are applied
with alarm in emergency times with socio-medical approaches.
As this regard, we evaluated four home based e-health care
systems which are, Tele-monitoring of patients system, home
care system, monitoring Alzheimer patient system, heart failure
management system. All of these are implemented in the
internet based platforms within emphatic on alarm and home
medical care. We also, present the non-critical systems like
home based e-health care systems and explain the functional
plans which have been performed in the past years in Iran such
as electronic prescription, taking online visit time, electronic
health records in hospitals and many more. These technologies
permit communications between patient and medical staff with
both convenience and fidelity, as well as the medical
transformation, imaging and health data from one site to clients
and cooperation with all of applied agents.
As a result, we recommend to increasing scalability of home
based health care systems over national and international levels
as well as real-time control of operations in the medical internet
based systems Alpha.
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