ITU Workshop on E-health services in low-resource settings

ITU Workshop on “E-health services in low-resource settings: Requirements and ITU role” (Tokyo, Japan, 4 -5 February 2013) BAN Portable Clinic toward Affordable Healthcare M 2 M Service Masahiro Kuroda Manager, Standardization Promotion Office, National Institute of Information and Communications Technology marsh@nict. go. jp Tokyo, Japan, 4 -5 February 2013

Epidemic of Obesity Communicable ? Yes and No Global status report on noncommunicable diseases (NCD) 2010 This report … particular attention … in low- and middle-income countries, which … bear nearly 80% of the burden from diseases like cardiovascular disease, diabetes, cancer and chronic respiratory diseases. The health consequences of the worldwide epidemic of obesity are also addressed. A large percentage of NCDs are preventable through the reduction of their four main behavioural risk factors: tobacco use, physical inactivity, harmful use of alcohol and unhealthy diet. (“Forward” from Dr Margaret Chan, Director-General, World Health Organization) Tokyo, Japan, 4 -5 February 2013 2

Obesity: Fat Burning with Joy Tissue oxygen saturation (St. O 2) is used to know whether entered aerobic-exercise state Measure de-oxidationized hemoglobin / oxidized hemoglobin by St. O 2 sensor Compute fat-burn grams from consumption calorie by 3 -axis accelerometer when entered aerobicexercise state Mobile phone vibrates when enter aerobicexercise state Body Area Network (BAN) Glimpse fat –burn amount Beautiful posture From Assoc. Prof. , Masatsugu Niawayama, Shizuoka university Tokyo, Japan, 4 -5 February 2013 3

Obesity: Essential Amino Acids Nutritive value is decided by lysine and other excessive amino acid is accumulated Wooden bucket theory as discharge or fat Balance in Essential amino acids isoleucine threonine methionine lysine Energy pooling as fat leucine histidine Cannot use for protein composition! From Prof. Osamu Tochikubo, Medical School, Yokohama City University Tokyo, Japan, 4 -5 February 2013 4

Preventive Medicine Prevent lifestyle-related illnesses for incipient and healthy people Living environment change … Hypertension(H), Abdominal obesity(O), Glucose intolerance(G), Lipidemia(L) and so on Lifestylerelated illness Lifestyle irregularity Alcohol(A) Smoking(S 1) Salt intake(S 2) Saturated fat(S 3) Stress(S 4) Sleeplessness(S 5) Lack of Exercise(E) and so on From Prof. Osamu Tochikubo, Medical School, Yokohama City University Tokyo, Japan, 4 -5 February 2013 5

Feedback Loop in Preventive Medicine General medical checkup Health industry Ubiquitous sensing Association of preventive medicine Analysis bank Sensor selection Acute care hospital Body Area Network (BAN) Nutritional supplements or exercise instruction Hospital Meal delivery industry From Prof. Osamu Tochikubo, Medical School, Yokohama City University Tokyo, Japan, 4 -5 February 2013 6

The BAN Standard IEEE 802. 15. 6 First Medical BAN published in 2012 1 common MAC with 3 PHYs PHY NB Media Access Contro l (MAC) PHY UWB PHY HBC From 15 -11 -0826 -01 -0006 -ieee-802 -15 -6 -tutorial Tokyo, Japan, 4 -5 February 2013 7

IEEE 802. 15. 6: Frequency Band Quality of Service is ensured Wireless LAN, Zig. Bee, Bluetooth 2. 4 GHz Tokyo, Japan, 4 -5 February 2013 IEEE 802. 15. 6 8

IEEE 802. 15. 6: Strict Security Enforcement Encrypted beacon Tokyo, Japan, 4 -5 February 2013 9

IEEE 802. 15 6: Priority Control Top-priority data transfer for emergency data Tokyo, Japan, 4 -5 February 2013 10

IEEE 802. 15. 6: Low Power Consumption Peak current 20 m. A Margin of processing in a sensor 10 m. A Rechargeable battery (Maxell CLB 2032) Bluetooth Low Energy Flexible processing in a sensor by low peak current IEEE 802. 15. 6 NB From 15 -11 -0826 -01 -0006 -ieee-802 -15 -6 -tutorial. ppt Tokyo, Japan, 4 -5 February 2013 11

IEEE 802. 15. 6: Secure SAR Level Protection from Radio Wave Environment SAR(Specific Absorption Ratio) is less than 2 W per every Kg Average power less than 20 m. W is outside of this limitation Narrow Band (NB) Designed at 1 m. W or less in ISM, Medical telemeter, and specific small electric power bands Ultra Wide Band (UWB) Below the allowable noise level (less than 41. 3 d. Bm/MHz< 20 m. W) Human Body Communication Weak radio level (<<20 m. W) *http: //www. tele. soumu. go. jp/j/sys/ele/body/protect/index. htm Tokyo, Japan, 4 -5 February 2013 12

Portable Clinic by Kyushu U. and Grameen Kyushu University and Grameen Communications prototyped an affordable “portable clinic” and experimented in villages and cities, Bangladesh Confirm functionalities and usability of the system NICT and the Qo. L-SN council provide BAN-based portable clinic functions for the experimental use Geneva, Switzerland, 26 -27 April 2012 13

BAN Portable Clinic Model Remote medical help center (Epidemiologic study) Remote database Point-of-care medical examination and remote diagnosis B-Logic Examinees Blood pressure Blood , Urine etc Diagnosis and prescription Cellular/Internet Use health-check devices for automatic categorization Portable health clinic management Paramedics Tokyo, Japan, 4 -5 February 2013 Non-invasive medical devices/sensors Blood test Urinalysis 14

B-Logic Green 　 Blood Pressure (mm. Hg) <140 mm. Hg <90 mm. Hg Blood Sugar <100 mg/dl Postprandial Blood Sugar Urine test <140 mg/dl 　 Yellow Orange 140≦ <160 mm. Hg 160≦　　　<180 90≦　<100 mm. Hg 100≦　　　<110 126≦　< 100≦　<126 mg/dl 200≦　< 140≦　<200 mg/dl 300 mg/dl 　 　 … Sp. O 2 Red 180≦ 110≦ ≧ 200 mg/ dl ≧ 300 mg/ dl 　 　 ≧ 96% 93≦　　<96% 90≦　　<93% <90% 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 Tokyo, Japan, 4 -5 February 2013 15

Medical Checkup and Remote Diagnosis in Rural Area Bangladesh Woman doctor for Women examinees Doctor’s remote exam. Remote examinee Wait for remote Start Physical examination scene Measured data on android tablet Reg. , Interview Informed consent Tokyo, Japan, 4 -5 February 2013 16

BAN-enabled Devices and Android Terminal Android terminal BAN blood pressure BAN Sp. O 2 sensor BAN waist meter BAN body Temperature BAN height meter BAN weight meter Open software/hardware and standard Tokyo, Japan, 4 -5 February 2013 17

Real Technologies for BAN Portable Clinic Unstable power supply and batteries may not be charged Data transfer via cell phone may not be available Limited space/location is available in setting up the clinic User-friendly interface for examiners Tokyo, Japan, 4 -5 February 2013 18

The Qo. L-SN Council is Working Promote and help in providing really usable experimental systems, such as health-check KIOSK in disasterstricken area, BAN portable clinic and others www. qolsn. org Tokyo, Japan, 4 -5 February 2013 19

M 2 M Service Platform ITU-T Focus Group is working on Healthcare M 2 M platform is an enabler of affordable BAN portable clinic because of sharing backend resources In the near future, large number of sensors are used for NCDs protection To keep Quality-of-Service, sensors require simple-and-cheap identification, such as PUF (physically unclonable function) Tokyo, Japan, 4 -5 February 2013 M 2 service platform 20

Feedback Loops in Preventive Medicine General medical checkup Self checkup Nutritional guidance with evidence Body Area Network (BAN) Nutritional supplements or exercise instruction M 2 M service platform Ubiquitous sensing Health industry Association of preventive medicine Analysis bank Hospital Acute care hospital Meal delivery industry From Prof. Osamu Tochikubo, Medical School, Yokohama City University Tokyo, Japan, 4 -5 February 2013 21

Conclusions and Recommendations Non communicable diseases are common issues in the world and can be reduced by preventive medicine using easy-to-use technologies with open standards The first medical BAN standard IEEE 02. 15. 6 is introduced for medical/health-related devices and sensors BAN-enabled Portable Clinic and the service is a good candidate to provide really usable functions for preventive medicine Experimentally use open standards, provide feedbacks to the standards, and then deploy everywhere 22

Thank you 23