Professor, Klinikum rechts der Isar, Munich, Germany
Senior Principal Consultant, Siemens, Germany
Huawei Technologies Duesseldorf GmbH, Germany
Educational Psychologist, Edinburgh Napier University, UK
All around the globe, e-Health has been a buzzword over the past 10 years or so. Although according to European studies the pick up rate of e-health in Europe is moderate, demographic data in most countries are speaking a clear language and it is unlikely that well established care models with hospitals as their centrepieces will be economically viable and sustainable in the future.
According to OECD figures healthcare costs all around the world will drastically increase. In comparison to 2006, healthcare costs in Germany and the US are expected to double by 2020, while the healthcare spending in China is predicted to grow more than seven fold until then. The fact that in most industrialised nations healthcare costs in general have been growing faster than the national gross domestic product (GDP)for a good number of years is alarming but there is no indication that this trend might reverse. So all in all, demographic and socio-economic factors suggest that new care models have to emerge primarily not so much in order to increase the quality of care but to release badly needed efficiency reserves not only in hospitals but across entire healthcare systems.
In Europe there is clear statistical evidence showing that the number of hospital beds has been continuously dropping since the 1990s while the number of day surgery interventions like in the case of Cataract and Tonsillitis have picked up year on year. Also, the number of outpatient episodes has been steadily growing with more people being seen on an outpatient basis than ever.
Policy makers and legislators throughout Europe have recently proposed to utilise m-health approaches to increase the self management capabilities of patients and their formal and informal care providers. The underlying ideas of applying (digital) technology to enable lesser skilled people to move ‘up-market’ and cover routine tasks of higher skilled individuals takes us to the ideas of Clayton Christensen, well known for his theory of ‘Disruptive Technologies’. From a systemic perspective this concept is looking at the emergence of dynamic distributed patient-centric care ‘cells’ which are flexible with regard to their members and proprieties and may connect to each other (peer-to-peer) for instance, to form self help groups. Individuals or groups might also integrate or establish contact with experts in central locations, whereby this does not imply expert centricity. Through means of virtualisation the point-of-care will clearly be shifted towards the patients or their individual peer-to-peer networks. Hospital care in the future is likely to be more the exception than the rule and will be reserved for cases such as major surgery, major illness or similar scenarios which would not be manageable outside hospitals.
Distributed patient-centred care has been accepted as a viable and most likely strategy to maintain the quality of care in the future, empower patients and increase the efficiency in healthcare systems. Recently the European Commission (EC) published infographics to highlight key parameters demonstrating the pickup of m-health. According to this, there have been 6 billion mobile subscriptions in 2014. According to Cisco figures, 2014 has been a very special year in so far that for the first time ever mobile subscriptions broke even with the number of people on this planet. Furthermore, the EC predicts the value of the global m-health application business at 17 billion Euro by 2017. More people than ever will use their mobile devices to monitor and manage their health, connecting with peers, specialists and with machines via the World Wide Web. Exponential growth rates are expected. This is clearly good news for many industrial domains and the world economy. However, some questions remain unaddressed.
Cisco figures suggest that the global mobile data traffic has grown between end of 2013 and end of 2014 by 70 per cent. Until the end of 2020 the data traffic is predicted to grow by a factor ten. Currently, the network does not grow at the same rate but according to Forbes the Internet of Things will be booming over the years to come, which will put additional stress on the mobile infrastructure. How will we be able to secure a highly reliable infrastructure that will meet the requirements of patients, healthcare experts, policy makers and legislators with regards to bandwidth, latency, reliability, safety and security for years to come? How can we enable the future of healthcare? How can we ensure accessibility and prevent digital exclusion, especially in rural areas? How can we cut costs and keep control of our carbon footprint?
When telecom operators started to offer 3G networks this was widely hailed as the silver bullet to cut latency and download times and enable a growing Internet with even quicker growing traffic. Now in many urban areas 4G technology is available and it has become clear that progress in the sense of ‘more of the same but faster’ will not be sufficient to really make m-health a ‘Disruptive Technology’. According to Christensen the decisive, distinguishing feature of a Disruptive Technology is the fact that it replaces an existing technology or strategy, thereby forcing existing providers out of their market dominating positions. The case of M-Health as a ‘Disruptive Technology’ with regards to how ‘health market participants’ access the ‘market place’ and how healthcare providers deliver healthcare clearly needs to be rejected as long as mobile networks are relatively slow and expensive and bandwidth consumption is capped as part of the telecom provider’s business model. However, recent scientific progress with regards to network technology suggests, that we are likely to witness a technological revolution, which could also fundamentally change the way healthcare is consumed and delivered.
Huge multi-national companies such as Ericsson, Nokia-Siemens, Huawei and others have been developing technologies to overcome current limitations in the network technology. Huawei and their strategic research partner, the University of Surrey (UK) have recently transported data at a rate of 1 TBit/s in their press release. At the heart of 5G Technology are different wave formats and protocols, which allow for less latency and more efficient data transmission through specific network environments. However, 5G technology offers more than just significantly higher transmission rates, lower latencies and faster backhaul systems. The overall network package will also allow on a high level allocation of ‘isolated’ virtualised networks to individual healthcare providing organisations excluding interference from third parties. This will be achieved by the use of Software Defined Networks (SDN). This will enhance safety, security and privacy for all parties and should lower litigation concerns in particular from the perspective of the healthcare providers. 5G will also enable patients to create their own individual care networks, which they will be able to administer easily on their smartphones. In these networks not only individuals will be interlinked but there will also be interaction with sensors and monitoring devices in order to enable formal and informal care providers to monitor patients. Patients will also be able to control access to their data although this data will typically be distributed in a variety of different databases across different organisations and networks. The technology will be able to manage files, such as MRT or CT files, which currently can only be shared via expert systems (Hospital Information Systems). Other potential future 5G enabled healthcare applications include the real time remote interventions with artificial organs, such as pacemakers, defibrillators, insulin pumps and brain pacemakers but also remote robotic surgery and remote surgical assistance. A very important future field of interest will be human machine interfaces, in particular with neurological structures, for example the support for visually impaired people.
A real world test bed has been announced during the opening of the Huawei 5G Vertical Industry Accelerator programme in Munich by the State of Bavaria, the City of Munich, Huawei and Technical University of Munich. Unsurprisingly one of the main foci was healthcare. During the course of 2015 and the years to follow, Klinikumrechts der Isar, the main teaching hospital for Technical University Munich, will be initially 4G LTE and successively 5G enabled. It is interesting enough to note that the German government has recently published a draft for e-health telematics legislation due to be rectified by parliament not later than 2016.The legislation is concerned with high-level regulation of reimbursement for telematic care, matters of governance and technical requirements such as interoperability. Legislative action has been proven a vital step towards the spread of tele-health adoption in the US and it has become widely accepted that legislative clarifications have to precede the role out of any technology to make it appeal to healthcare providers.
The technological approach in Munich will not only cover new protocols and wave forms but will also consider new architectural designs, such as Mobile Edge Computing (MEC). MEC or also known as Mobile Edge Clouds has been known and discussed as a concept for some time. However, it has never left the lab for wider testing.
Mobile Edge Computing for e-Health and m-Health
With the motto ‘solve local problems locally’, MEC is the emerging paradigm wherein application and service deployment can be performed within a cloud like environment provided to the mobile network edge. Typically such a cloud is installed in the proximity of a mobile base station and will have the scope of its services bounded by a given geographical area. This approach provides significant reduction in data transmission latencies and is in stark contrast to the traditional applications and services that are deployed over a cloud connected to the core network. shows a schematic view of MEC in a mobile communication system. The concept of providing computing resources at the network edge to reduce latencies is nothing new and was developed around 2004 to provide lower response times for enterprise web applications. In the area of mobile communications, the idea however has only been recently introduced. An MEC Industry Specifications Group (ISG) was recently established within European Telecommunications Standards Institute (ETSI) to standardise and develop interoperable MEC architectures.
Compared to the traditional edge computing, MEC goes beyond reducing latencies. In MEC, the network is expected to provide context-awareness to the services deployed over the edge cloud in a safe and secure manner. This contextual information would include the location and features of the individual connected devices among many other things. It is envisioned that MEC when combined with other evolving concepts in 5G would provide effective real-time context-awareness collaborations between devices and/or users. In the context of healthcare, such a system would be a holy grail that could enable a plethora of future e-Health and m-Health scenarios. For example, surgeons located in different are as of a hospital could collaborate over the MEC to perform remote robotic tele-surgeries. And, in the scenario of elderly care, if some patients need immediate assistance, the MEC could immediately locate and inform the certified caretakers available in the vicinity. Furthermore, MEC is local to a given geographical location. This means that with MEC, privacy of the medical data can be emphasised by limiting its storage and processing to the hospital region. This in turn avoids the risk of exposure which might be caused due to transmission and processing of the data beyond the hospital boundaries and in the core network as it often happens with the current systems.
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Christoph Thümmler is Professor for e-Health at Edinburgh Napier University and also collaborative researcher at Technical University Munich, Germany.Christoph completed a PhD on cerebral haemodynamics with distinction before training to become a General Physician. His current interests include the utilisation of superfast networks in healthcare and the virtualisation of care.
Tom Jell is Program Manager for the department Technology and Innovation and Senior Principal Expert at Siemens Mobility Division (Munich and Beijing). His research focus is on secure eHealth solutions introducing hybrid clouds based on a software to data approaches as well on resilient fault tolerant industry systems and Reliable Systems.
Swaroop Nunna is a research engineer in the future wireless network technologies group at the Huawei European Research Center, Munich. Swaroop received his Masters in Communication Engineering from Technische Universitaet Muenchen, Germany. His current research interests aim at establishing an integrated connectivity framework for Internet of Vehicles and Internet of Things environments.
Ai Keow Lim is a Research Fellow working with the EU FI-STAR project team at Edinburgh Napier University.She obtained her MSc and PhD in Education from the University of Edinburgh. Her research interests include social and psychological aspects of human-machine interaction, Internet research ethics and educational aspects of Internet-based learning.