Feature

Transition of eHealth and mHealth to uHealth

One of the most promising approaches in building wearable health monitoring systems is the utilisation of the emerging Wireless Body Area Networks, says Dr NK Singh

A remarkable develop-ment, parallel to the PC revolution in scale and impact, is the consumer adoption of mobile technologies. Added to this are the rapid advances being made in the field of ubiquitous computing and reconfigurability designs for bio-computing needs. UHealth and mHealth are emerging paradigm for healthcare environment, in which mobile devices blend into the background seamlessly — collaborating almost 'intelligently' — to provide healthcare/supportive services for consumers/stakeholders. eHealth, as popularly understood, rides on ICT literacy, penetration of PC technologies and confined patches of connectivity — either point-to-point or multipoint-to-multipoint.

Given the fact that mobile technologies adoption has given both, computing power and connectivity (and rechargeable power source) an exponentially wider reach, it is offering new ways to improve health systems' efficiency and effectiveness. As per Teleceom Regulatory Authority of India (TRAI's) latest figures, the number of Indians using their mobiles to login to the internet has increased from 16 million in 2006 to 38 million in 2007 (both GSM and CDMA). Even analysts believe that data usage is becoming a significant source of revenue and is expected to outpace voice-based VAS services by 2011.

Developments in the mobile sector have changed the ICT landscape globally. With several technologies 'grappling to collaborate' on 'viable' problem definition that could match the appetite of the ICT industry, policy makers and health economists seem to have converged on the beneficial impact of eHealth, if not the choice of standardised technological components. Amidst this, we have the emergence of wireless sensor network enabled human health monitoring system, driven by wearable biosensors. These sensors- capable of capturing human health parameters ranging from blood pressure to Electrocardiogram (ECG) and muscle movements - are placed at specific locations on the human body (non-invasive).

One of the most promising approaches in building wearable health monitoring systems is the utilisation of the emerging Wireless Body Area Networks (WBANs) that can monitor various vital signs, providing real-time feedback to the user, supportive care givers and the medical personnel.

A WBAN consists of multiple sensor nodes, each capable of sampling, processing and communicating one or more human health parameters (heart rate, blood pressure, oxygen saturation, activity) or environmental parameters (location, temperature, humidity, light). Typically, these sensors are placed at specific places on the human body as tiny patches or hidden in users' clothes, allowing ubiquitous health monitoring in their native environment for extended periods of time. The emergence of wearable biosensors are now beginning to 'confidentially shake hands' with mobile platforms supported by a framework of ubiquitous network, paving the way for merger of eHealth and mHealth, leading to uHealth.

Usage Model

The health-monitoring network is an integration of sensor body area network into a broader multi-tier health oriented ICT system. The initial layer spans a network comprising of individual health monitoring systems that connect through the internet to a Community Health Server (CHS). The CHS is optimised to service a large number of individual users and enables collaboration of a complex network of interconnected services, medical personnel, policy makers, drug stores, insurance agents, police and of course, healthcare professionals.

Each user wears number of sensor nodes at specific locations (for example: the wrist for blood pressure or front of the chest for the electrical activity of the heart) for specific disease monitoring. The primary function of these health sensor nodes is to accurately sample human health parameters (physiological). These samples are then transferred to the Personal Health Server (PHS) through wireless personal network that could be implemented on a Personal Digital Assistant (PDA), cell phone, or home personal computer, using ZigBee or bluetooth. The PHS sets up and controls the WBAN, provides graphical or audio interface to the user and transfers the information about health status to the Community Health Server through the internet or mobile telephone networks (GPRS, 3G).

The Personal Health Server keeps Electronic Medical Records (EMRs) of registered users and provides various services to the users, medical personnel and informal caregivers. It is the responsibility of the Community Health Server to:

• Authenticate users.
• Accept health events sessions, downloads or uploads.
• Analyse the data.
• Format and insert this session data into corresponding medical records.
• Recognise serious health anomalies in order to contact emergency care givers, and
• Forward new instructions to the users, such as physicians' disease management protocols/therapeutic instructions, etc.

A ring of such Community Health Servers could be centralised further at a state level integration center with disaster support. The consumer's health service provider could access the data from his/ her office via the internet and examine it to ensure that:

• The consumer is within expected physiological limits (heart rate, blood pressure, activity),
• The consumer is reacting well to a given treatment or
• The consumer has been performing the prescribed therapeutic related instructions.

Legal and commercial transactions can then be authenticated by specific software agents, which reside in the server that gets integrated at the back-end to respective governance framework at the state or national level, thus completing the scenario.

The Global Scenario that will Fuel uHealth

The increasing gap of population that needs care and the required number of available health personnel for at least next two decades, coupled with the rapid penetration of mobile and network technologies including 3G and broadband wireless, will give way to care enabled by non-medical professionals akin to trained health assistants (like ASHA within the framework of the National Rural Health Mission of Government of India / the nursing assistant in a sub centre).

Locally within the political system of a state or province (interpreted as community healthcare), we will see more and more efforts being placed on non-medical personnel doing most of healthcare delivery/maintenance work, empowered by both health policies and an ever-connected mobile computing device. This shift will again fuel emerging technologies to work ubiquitously and almost intelligently to support human health monitoring and disease prevention, driving down cost of care.

The Economic Paradigm

If providing better healthcare is about:

• Enabling people to occupy the centre of development,
• Policy makers exploring challenges including poverty, gender, democracy, human rights, cultural liberty, globalisation, water scarcity and climate change (in the context of health polity),
• The increasing role of eHealth and mHealth, transforming societies by empowering human to gain control of their health, then we might be able to bring sustainable paradigm shift, encapsulated in a dynamic mix of affordability, equitability yet cutting-edge modern medical care and diagnostics, whenever telecom and ICT stretches its arms around burgeoning communities, in the far reaching areas of the planet. The wealth created by some new players within societies however, is the flip side of the 'new economic readjustment.' Hopefully, we will see many existing players in the game.

The promise that this trend will set to transform health system across global and local communities in both urban and rural places, could possibly provide the required business dimension for the ICT players for at least next two decades before nanomedicine and personalised gene therapy takes over. The most effected area, of course, will be human health monitoring and disease prevention. The economic gain that will save nations is bound to give health policy makers and health economists the much-awaited surprise and some sleep.

The Challenge Of The Industry

While 'care' itself will continue to remain fragmented because of economic 'non-alignment' within the framework of healthcare policy, polity and its influential stakeholders, eHealth and mHealth along with ubiquitous and reconfigurable technologies will lend significant 'economic stitching' by abstracting layers of care paradigm, while securing privacy and confidentiality, enabling value exchange of a commercial scale.

This will offer multidimensional challenge. One, in terms of existing verticals (hospitals, pharmacy, devices, health insurance) resisting the emerging 'economic model,' as many old ways of sustenance will suddenly disappear- as if they never ever existed! Another challenge is scalability.

Ubiquitous computing requires flexibility. Fusing distributed computing devices into everyday life implies the need to adapt to evolving standards and dynamic environments. Furthermore, to gain user acceptance, such devices should be able to adapt to different usage patterns and user profiles. ICT players will need to refresh and relook again into applying the concept of reconfigurability on different abstracted care layers.

The most significant challenge that will exist long enough to impact success of this emerging paradigm is the ethical risk of uHealth impacting consumers, providers and the influential stakeholders within the healthcare industry. Nevertheless, innovation mandated by the global shift of demography on the backdrop of health affordability, will continue to accelerate this paradigm of mHealth and uHealth. The paranoid, who realises that, today's business will cease unless we act in time to innovate and 'kick the existing old habits' will survive.

In Essence

The demographic shift, the rising cost of care and shifting burden of morbidity/ mortality (non-communicable diseases) comprises the 'constant' in the dynamic equation of the sustainability question of 'healthcare'. The exponentially expanding ICT and mobile network and the technological innovations in health sensors and ubiquitous computing will be the 'dynamic' parameters that will decrease the cost of care, if made to work together in a 'cultural fit.' The economic leveling is certain to happen, benefiting the population in many parts of the world, where both modern medicine and cutting-edge ICT have not yet delivered its promises.

While wooing consumers and providers and their facilitators remains a task for 'all to work,' the required quantum of push is likely to emerge from success models in the urban areas wherein wireless body area networks coupled with mobile devices (if not lifestyle) 'reconfigures' into a framework of ubiquitous care network, delivering uHealth that is highly personalised for the consumers. Such economic models for supporting people in urban areas (people with special needs like the elderly and vulnerable) are likely to gain the initial legal support from innovative health insurance policies/ pay for service models. If the conflicting requirements of form factors, accuracy, operating time, and reliability gets resolved with viable economic models, the emergence of uHealth might happen sooner than expected.

The writer is Co-Founder-CEO, iHCX
nk.thokchom@ihcx.com