1. Tokyo, Japan, 4-5 February 2013 BAN Portable Clinic toward Affordable Healthcare M2M Service Masahiro Kuroda Manager, Standardization Promotion Office, National Institute of Information and Communications Technology marsh@nict.go.jp ITU Workshop on E-health services in low-resource settings: Requirements and ITU role (Tokyo, Japan, 4-5 February 2013)

2. 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

3. Obesity: Fat Burning with Joy Tissue oxygen saturation (StO2) is used to know whether entered aerobic-exercise state Measure de-oxidationized hemoglobin / oxidized hemoglobin by StO2 sensor Compute fat-burn grams from consumption calorie by 3-axis accelerometer when entered aerobic- exercise state From Assoc. Prof., Masatsugu Niawayama, Shizuoka university Mobile phone vibrates when enter aerobic- exercise state Body Area Network (BAN) Glimpse fat –burn amount Beautiful posture Tokyo, Japan, 4-5 February 2013 3

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

5. Prevent lifestyle-related illnesses for incipient and healthy people Hypertension(H), Abdominal obesity(O), Glucose intolerance(G), Lipidemia(L) and so on 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 Lifestyle- related illness Lifestyle irregularity Living environment change … 5 From Prof. Osamu Tochikubo, Medical School, Yokohama City University Preventive Medicine Tokyo, Japan, 4-5 February 2013

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

7. PHY NB PHY UWB PHY HBC Media Access Control (MAC) First Medical BAN published in 2012 1 common MAC with 3 PHYs From 15-11-0826-01-0006-ieee-802-15-6-tutorial 7 The BAN Standard IEEE802.15.6 Tokyo, Japan, 4-5 February 2013

8. IEEE802.15.6: Frequency Band Wireless LAN, ZigBee, Bluetooth 2.4GHz IEEE802.15.6 Quality of Service is ensured Tokyo, Japan, 4-5 February 2013 8

9. IEEE802.15.6:Strict Security Enforcement Encrypted beacon Tokyo, Japan, 4-5 February 2013 9

10. IEEE802.15 6:Priority Control Top-priority data transfer for emergency data Tokyo, Japan, 4-5 February 2013 10

11. 20mA 10mA Bluetooth Low Energy IEEE802.15.6NB Margin of processing in a sensor Peak current Rechargeable battery (Maxell CLB2032) Flexible processing in a sensor by low peak current From 15-11-0826-01-0006-ieee-802-15-6-tutorial.ppt IEEE802.15.6:Low Power Consumption Tokyo, Japan, 4-5 February 2013 11

12. Protection from Radio Wave Environment SAR(Specific Absorption Ratio) is less than 2 W per every Kg Average power less than 20mW is outside of this limitation Narrow Band (NB) Designed at 1mW or less in ISM, Medical telemeter, and specific small electric power bands Ultra Wide Band (UWB) Below the allowable noise level (less than - 41.3dBm/MHz< 20mW) Human Body Communication Weak radio level (<<20mW) IEEE802.15.6:Secure SAR Level *http://www.tele.soumu.go.jp/j/sys/ele/body/protect/index.htm Tokyo, Japan, 4-5 February 2013 12

13. Portable Clinic by Kyushu U. and Grameen Geneva, Switzerland, 26-27 April 2012 13 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 QoL-SN council provide BAN-based portable clinic functions for the experimental use

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

15. GreenYellowOrangeRed Blood Pressure (mmHg) <140 mmHg 140 <160 mmHg160 <180180 <90 mmHg 90 <100 mmHg100 <110110 Blood Sugar<100mg/dl 100 <126mg/dl 126 < 200mg/dl 200mg/d l Postprandial Blood Sugar <140mg/dl 140 <200mg/dl 200 < 300mg/dl 300mg/d l Urine test … SpO2 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 B-Logic Tokyo, Japan, 4-5 February 2013 15

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

17. BAN height meter BAN weight meter Android terminal BAN blood pressure BAN SpO2 sensor BAN waist meter BAN body Temperature BAN-enabled Devices and Android Terminal Tokyo, Japan, 4-5 February 2013 17 Open software/hardware and standard

18. 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

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

20. M2M Service Platform ITU-T Focus Group is working on Healthcare M2M Healthcare M2M 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 20 M2 service platform

21. Feedback Loops in Preventive Medicine Meal delivery industry Association of preventive medicine Hospital Acute care hospital General medical checkup Nutritional supplements or exercise instruction Health industry Ubiquitous sensing 21 Body Area Network (BAN) From Prof. Osamu Tochikubo, Medical School, Yokohama City University M2M service platform Analysis bank Self checkup Tokyo, Japan, 4-5 February 2013 Nutritional guidance with evidence

22. 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 IEEE02.15.6 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 Conclusions and Recommendations

23. Thank you 23