M-Health Solutions Using 5G Networks and M2M Communications: It Trends in Healthcare It Trends in Healthcare

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IT TRENDS IN HEALTHCARE

M-Health Solutions
Using 5G Networks
and M2M
Communications

Willian D. de Mattos and Paulo R.L. Gondim, University of Brasília

The authors present recent research linking the growing mobile


health (m-health) field with the need for 5G and machine-to-machine
technologies. They explore the multiple benefits that these emerging
technologies could offer to broadly expand m-health solutions.

S
ince the 1950s, the scientific and indus- to the electronic health (e-health) field, while
trial communities have proposed using the integration of mobile computing, medical
electronic and computer technology in sensors, and portable devices in the health en-
healthcare. In recent decades, society vironment has enabled the subfield of mobile
has seen breakthroughs in technology that sig- health (m-health). Although there are similarities
nificantly change peoples’ behavior and needs between e-health and m-health, they also have
and are poised to revolutionize the healthcare some differences. Whereas e-health, in a gen-
field. These advancements have occurred mainly eral way, is using ICT for healthcare, m-health
due to the emergence and evolution of Internet adds to e-health a specific focus on exploiting
and mobile communications. Such technologies advances in mobile communications, ubiquitous
are being widely used to develop medical solu- computing, and wearable technologies.
tions that make patient information available In the past decade, mobile communication
anytime and anywhere. technology has achieved significant advancements
Computer technologies, modern equipment, in coverage, service usage, and transmission rates.
and ICT for healthcare solutions have given rise Today, mobile networks support more than 3.6

24 IT Pro May/June 2016 Published by the IEEE Computer Society 1520-9202/16/$33.00 © 2016 IEEE
billion users worldwide, with wireless coverage What Is 5G?
reaching more than 85 percent of the world’s pop- Essentially, 5G denotes the next generation of ex-
ulation,1 which is much more than the electricity isting 4G communication networks that can pro-
distribution system can currently reach. vide a huge step ahead as regards network speed,
Several wireless and mobile network tech- capacity, and scalability. The technology vision,
nologies have arisen to enable myriad services, capabilities, and standards for 5G are still under
including voice and data communications with extensive discussion and definition.
enhanced mobility features. An extensive dis- At the beginning of 2013, China’s govern-
cussion is currently under way involving the fifth ment established the International Mobile Tele-
generation of wireless networks. Unlike 3G or communication 2020 (5G) Promotion Group, or
even 4G, these networks offer interesting possi- IMT-2020 (5G), as a significant effort toward de-
bilities for meeting the unique requirements of veloping 5G research.4 In the same year, the 5G
m-health scenarios. Public-Private Partnership (5G PPP) was initiated
In the near future, billions of mobile devices in Europe.5 At the end of 2015, 5G PPP and IMT-
will be connected to the Internet2; this growth 2020 (5G) announced a memorandum of under-
will be faster than current technologies can sup- standing and are now working together on the
port. Furthermore, machine-to-machine (M2M) 5G vision, requirements, concepts, and techno-
and device-to-device (D2D) communication logical architecture.
technologies will be deployed on a large scale. In July 2015, the International Telecommuni-
Thus, 5G networks offer new possibilities for cation Union (ITU) defined its vision and road-
evolving m-health solutions that have a constant map for 5G mobile development and established
need for faster, more secure, and scalable mobile the term “IMT-2020” for it. The process is con-
networks with very low latency. tinuing in the ITU with the close collaboration
Here, we define 5G networks and look at glob- of industry and governments. As one relevant
al efforts to realize the vision and requirements result of this ongoing project, the ITU has de-
that would make them a reality. We also exam- fined some parameters that can be considered
ine future 5G standards and the advances that key c­ apabilities for 5G technology:6
m-health applications should be able to achieve.
• Peak data rates should reach 10 Gbps; 20 Gbps
M-Health peak data rates can be expected under certain
In a broad sense, m-health is the delivery of conditions and scenarios.
healthcare services through mobile devices, • Services will be supported that have very low
which are used to capture, analyze, store, and latency requirements (less than or equal to 1
transmit health information from multiple ms).
sources, including sensors and other biomedical • The network will enable high mobility (up to
acquisition systems. M-health offers an elegant 500 km/h).
solution to a problem commonly faced in the • It will support a high connection density en-
medical field: how to access the right informa- abling massive machine-type communication
tion where and when needed in highly dynamic (MTC) scenarios.
and distributed healthcare organizations. • The network will enable 100× more energy ef-
Mobile applications for health can address ficiency and 3× more spectrum efficiency.
different audiences, such as doctors, nurses, pa-
tients, and even healthy people.3 Solutions can According to the ITU, these capabilities are
be used to encourage, for example, a reduction targets for IMT-2020 research and investiga-
in cigarette consumption, adherence to weight tion and can be further revised. Furthermore,
loss diets and physical activity plans, or adher- the relevance of these capabilities can be dif-
ence to treatment plans aimed to control and ferent according to the use case or scenario
prevent heart disease. As a result, m-health so- studied.
lutions can decrease medical errors and improve Regarding the 5G architecture, the technol-
the efficiency and effectiveness of health servic- ogy will need to support legacy radio access tech-
es, thereby reducing operating costs. nologies (RATs) and fixed access, and provide an

computer.org/ITPro 25
IT Trends in Healthcare

Common 5G core functionality


 Flexible deployment of network functions
 Service enablers and optimizations
 Common functional toolbox
ms has been classified as acceptable,
 Utilizing network functions virtualization and with a limitation of 100 ms predict-
Common
management
software-defined networking ed for future telesurgery systems.10
and transport 5G radio access Legacy RATs Fixed access However, robotic systems have an in-
One access network herent latency of approximately 100
(LTE-compatible) ms. 5G networks can reduce com-
3 GHz 100 GHz munication latency to less than 1 ms.
Thus, as new medical telesurgery ap-
plications with strict latency require-
Figure 1. High-level 5G architecture. The framework also considers the
ments arise, modern solutions might
support of legacy radio technologies. (Adapted from “5G Radio Access.” ) 8 become possible in the healthcare
environment. In this future scenario,
a patient that needs an urgent or spe-
integrated access network approach, including cialist operation could be virtually operated on
techniques compatible with LTE. Also, the radio by a surgeon located anywhere in the world.
access network will be ultra-dense and will need
to fully use the entire frequency range from 3 to Bandwidth
100 Ghz.7 Figure 1 illustrates this high-level 5G The current bandwidth restrictions of 3G and
architecture.8 4G networks limit the amount of information
Finally, the 5G core network will likely use biomedical sensors can send, especially for ap-
network function virtualization and software- plications monitoring in real time. A major ben-
defined networking to provide a high level of efit of future 5G networks will be the ability to
scalability and agility with common management support higher frequencies (including those
and transport layers, increasing overall network higher than 10 GHz). The main advantage of
performance. working with these frequencies is the ability to
use more spectrum, thus supporting very high
5G Networks for M-Health Solutions transmission rates (on the order of Gbps). This
The purpose of the 5G network is not only to high-speed 5G network will let physicians see
connect people but also to provide connectivity high-resolution images remotely and enable the
to any device or application that benefits from deployment of healthcare solutions that stream
network access. Mobile technology evolution is ultra-high-definition (UHD) content. Further-
a key component for the comprehensive devel- more, the communications support that 5G net-
opment of M2M communications and the In- works will provide involves a scalable and flexible
ternet of Things (IoT). Future 5G capabilities9 way to allocate bandwidth, which will allow the
could generate significant improvements in many widespread adoption and expansion of M2M and
health scenarios, including the management and D2D solutions in the medical field. These solu-
tracking of hospital assets, robotics-assisted tele- tions can use smart devices, such as wearable
surgery, assisted living and remote monitoring of sensors, implantable medical devices (IMDs), or
health or wellness data, and remote application of remote monitoring equipment.
medication (smart medication).
Figure 2 illustrates the key 5G capabilities that Scalability, Network Capacity,
will have significant importance in improving m- and Massive Numbers of Devices
health solutions for these scenarios (and many Considering the mass deployment of biomedi-
others), which we discuss next. cal sensors with IoT capabilities, device-gen-
erated data could exceed network capacity.11
Very Low Latency Thus, a new network infrastructure must
Low latency is a frequent requirement for m- ­support massive data capacity and a high num-
health applications. For telesurgery solutions, ber of connection requests. Support for M2M
latency in communication has a direct impact on and IoT solutions is crucial to the success of 5G
the process of manipulating the robotic instru- networks. The network infrastructure must be
ments. An end-to-end latency of less than 200 ­dynamically scalable enough to manage s­ ignaling

26 IT Pro May/June 2016


Bandwidth
traffic and transmission to a massive number of
biomedical devices with different traffic patterns.
In m-health solutions, scalability is an impor- Very low
latency Scalability
tant feature because the network must allow for
a seamless increase or decrease of nodes with-
out affecting network operation. The support for
massive MTCs is important in situations with a 5g
massive number of low-cost or low-complexity and
Reliability, m-health
devices with nondelayed and nonsensitive data. resilience, Network
and capacity
For massive MTCs, there is also a need for a scal- security
able and flexible network with wide coverage.

Long Battery Lifetime


Long Massive
To connect billions of sensors and biomedical ac- battery number of
tuators, the availability of low-cost devices and an lifetime devices
extended battery life are necessary. For m-health
scenarios of remote monitoring, the target is to
implement connected devices that are self-sus- Figure 2. Key 5G capabilities for mobile health
tainable for the full duration of medical treatment. (m-health) solutions. These capabilities can improve
The requirement for 5G is intended to avoid a bat- m-health solutions in many scenarios.
tery charge or replacement for at least 10 years.
bile edge computing (MEC) to provide an ad hoc
Security system of collaboration in real time and based on
Due to an expected increase in the type of stake- context.13 They show a use case related to remote
holders and number of tenants in 5G networks, telesurgery, which has stringent requirements
security issues will be radically amplified. 5G for latency and application criticality. This work
networks should be able to deal with new busi- points out that 5G technologies and MEC are still
ness models, an IT-driven network architecture, in the preliminary development stages, but that
heterogeneous and ubiquitous access, and en- they will be able to evolve to become revolution-
hanced privacy protection. ary in boosting the e-health and m-health fields.
Finally, Balasubramanian Arunsundar and
Recent Studies on 5G and M-Health Rajavelu Srinivasan propose a new architecture
Few studies explore the potential of 5G technol- based on ubiquitous 5G for telemedicine that
ogy to improve and evolve m-health applications. uses cognitive networks and multiple-input/
The works we discuss next follow this approach, multiple-output technology.14 In the proposed
linking the future benefits and advances of 5G architecture, indoor and outdoor scenarios are
technology to the current and future needs of differentiated to increase the efficiency of data
medical applications. transmission according to the environment.
Amitabh Mishra and Dharma P. Agriwal pro-
pose a new architecture for continuously sending M2M/D2D Communication for
physiological data with low consumption.12 More- M-Health Solutions
over, they assume that 5G technologies will en- By using a heterogeneous communications net-
able a considerable increase in transmission rates work, M2M communications and MTC allow
and must provide dedicated channels for process- for interconnection between intelligent devices
ing and delivering relevant biomedical data. Thus, without the need for human intervention. A sim-
these resources allow service continuity in cases plified M2M architecture for mobile health solu-
of network congestion. The authors declare that tions is schematically represented in Figure 3.15
by offering these features, 24-7 remote patient The architecture is divided into three parts:
monitoring solutions could soon become a reality. the device domain, which contains the M2M de-
Swaroop Nunna and his colleagues explain vices; the network domain, which handles mes-
how 5G technologies can be combined with mo- sage transmission between M2M devices and

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IT Trends in Healthcare

Application Network M2M device


domain domain domain

M2M disease management and aging inde-


application pendently are the most prominent
M2M
devices patient monitoring use cases con-
M2M
sidered. The document provides an
core analysis of specific security issues
network related to the handling of electronic
Service health records (EHRs) in the context
Client capabilities M2M of M2M communication.
application gateway
• Wellness services. This use case con-
siders many scenarios based on the
use of wellness sensor devices using
M2M area network technology. Due
to the severe limitations of power
consumption and processing capacity
regarding sensors, the data collected
can be transferred to a gateway that
Figure 3. Simplified machine-to-machine (M2M) architecture for mobile will collect and subsequently submit
health solutions. The architecture considers a heterogeneous wireless the information. In this use case, the
network. (Adapted from “A Survey on M2M Systems for M-Health: M2M gateway considered is a mo-
A Wireless Communications Perspective.”15) bile device, such as a smartphone or
tablet. The report considers a list of
back-end servers; and the application domain, security and communication requirements for
which runs the tools performing processing on integrating the M2M application domain, mo-
the received data. bile devices, and M2M sensors.
M2M technology opens up a new range of pos-
sibilities in the medical field, enabling mobile and Also, direct D2D technology has leading devel-
ubiquitous m-health solutions. Current efforts to opment potential, enabling devices that connect
develop M2M solutions have focused mainly on directly with or without the need for control or
standardization and interoperability activities. A network assistance. D2D is an excellent alter-
global standardization body for M2M and IoT called native for devices to communicate in situations
oneM2M was established and currently includes where the conventional cellular communica-
seven standards organizations and more than 200 tions link is unavailable, such as natural disaster
companies.16 Its oneM2M Global Initiative focus- scenarios.18 In such cases, connectivity between
es on establishing a common M2M service layer health professionals and medical devices is
platform for global and access-independent M2M among the highest priorities.
services. One important result of the oneM2M
initiative is a technical report that includes some

B
important use cases related to a broad range of seg- y the end of 2020, hundreds of millions of
ments, including the healthcare field. The follow- devices will be working with healthcare-
ing healthcare use cases were considered:17 related M2M technology. To ensure com-
munication and interoperability among medical
• M2M healthcare gateway. This use case is devices for different purposes and with different
related to equipment that allows bidirectional
­ traffic characteristics, the 5G architecture will
­communication between healthcare ­sensors (the have a central role in several m-health scenarios.
M2M device domain) and back-end ­servers (the To effectively disseminate m-health solutions so
m-health application domain). This use case re- that they become a reality, the 5G network and
sults in a list of requirements, such as equipment M2M technology should meet medical devices’
buffer capacity and quality-of-service policies. current and future needs. Here, we aimed to con-
• Secure remote patient care and monitoring. In this solidate the recent work relating to 5G, M2M, and
case, the person being monitored uses one or m-health technology as well as explore the poten-
more wearable or implantable sensors. ­Chronic tial that these technologies have to a­ ddress open

28 IT Pro May/June 2016


challenges and problems. This window of oppor- 12. A. Mishra and D.P. Agrawal, “Continuous Health

tunity paves the way for discussing ­future mobile Condition Monitoring by 24x7 Sensing and Trans-
network requirements. The strict ­requirements of mission of Physiological Data over 5-G Cellular
future mobile networks and communication de- Channels,” Proc. Int’l Conf. Computing, Networking, and
vices should not be ignored, because m-health’s Communication (ICNC), 2015, pp. 584–590.
success is closely linked to the development of 13. S. Nunna et al., “Enabling Real-Time Context-

these capabilities. Aware Collaboration through 5G and Mobile
Edge Computing,” Proc. 12th Int’l Conf. Informa-
References tion Technology—New Generations (ITNG), 2015,
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3. C. Free et al., “The Effectiveness of Mobile-Health mon M2M Service Layer Platform: Introduction to
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ments, white paper, IMT-2020, 2014; www.imt-2020. 8501/01.00.00_60/tr_118501v010000p.pdf.
cn/en/documents/download/3. 18. S. Adibi, “A Mobile Health Network Disaster Man-
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Services, 5G-PPP, 2015; https://5g-ppp.eu/wp-content/
uploads/2015/02/5G-Vision-Brochure-v1.pdf. Willian D. de Mattos is working toward an MSc in
6. Recommendation ITU-R M.2083-0. IMT Vision—Frame- the electrical engineering department at the University of
work and Overall Objectives of the Future Development of Brasília, Brazil. His research interests include telecom-
IMT for 2020 and Beyond, Int’l Telecommunication munications networks and mobile health applications. De
Union-Radiocommunication Sector, 2015; https:// Mattos received his Lato Sensu degree in telematics and
www.itu.int/dms_pubrec/itu-r/rec/m/R-REC-M.2083 computer networks from the Federal University of Technol-
-0-201509-I!!PDF-E.pdf. ogy–Paraná (UTFPR), Brazil, and a BSc in electrical en-
7. Network Architecture for the 5G Era, white paper, Nokia, gineering from the Federal University of Paraná (UFPR),
2015; http://networks.nokia.com/sites/default/files/ Brazil. Contact him at wdmattos@aluno.unb.br.
document/nokia_5g_architecture_white_paper.pdf.
8. E. Dahlman et al., “5G Radio Access,” Ericsson Rev., Paulo R.L. Gondim is an associate professor in the electrical
vol. 91, no. 1, 2014, pp. 42–47. engineering department at the University of Brasília, Brazil,
9. 5G-PPP White Paper on E-Health Vertical Sector, white where he has served as an advisor on doctoral theses and more
paper, 5G-PPP, Sept. 2015; https://5g-ppp.eu/wp than 25 master’s degree dissertations. His ­research interests
-content/uploads/2014/02/5G-PPP-White-Paper-on include information security, communication networks, qual-
-eHealth-Vertical-Sector.pdf. ity of service and experience, and multimedia transmissions.
10. Q. Han, S. Liang, and H. Zhang, “Mobile Cloud
Gondim has also served on the editorial advisory boards of the
Sensing, Big Data, and 5G Networks Make an Intel- International Journal of E-Health and Medical Com-
ligent and Smart World,” IEEE Network, vol. 29, no. 2, munications and Recent Advances in Communica-
2015, pp. 40–45. tions and Networking Technology, and as a reviewer
11. H. Shariatmadari et al., “Machine-Type Communica- for several periodicals and conferences, and has published
tions: Current Status and Future Perspectives toward more than 70 papers in periodicals and for technical scientific
5G Systems,” IEEE Comm., vol. 53, no. 9, 2015, pp. 10–17. events. Contact him at pgondim@unb.br.

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