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Smart Health: A Context-Aware Health Paradigm within Smart Cities

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SOLANAS_LAYOUT.qxp_Layout 7/30/14 2:00 PM Page 74
CONTEXT-AWARE NETWORKING AND
COMMUNICATIONS
Smart Health: A Context-Aware
Health Paradigm within Smart Cities
Agusti Solanas, Constantinos Patsakis, Mauro Conti, Ioannis S. Vlachos, Victoria Ramos,
Francisco Falcone, Octavian Postolache, Pablo A. Pérez-Martínez, Roberto Di Pietro,
Despina N. Perrea, and Antoni Martínez-Ballesté
ABSTRACT
The new era of mobile health ushered in by
the wide adoption of ubiquitous computing and
mobile communications has brought opportuni-
ties for governments and companies to rethink
their concept of healthcare. Simultaneously, the
worldwide urbanization process represents a
formidable challenge and attracts attention
toward cities that are expected to gather higher
populations and provide citizens with services in
an efficient and human manner. These two
A. Solanas, P. A. Pérez- trends have led to the appearance of mobile
Martínez, and A. health and smart cities. In this article we intro-
Martínez-Ballesté are with duce the new concept of smart health, which is
the Universitat Rovira i the context-aware complement of mobile health
Virgili. within smart cities. We provide an overview of
the main fields of knowledge that are involved in
C. Patsakis is with the the process of building this new concept. Addi-
University of Piraeus. tionally, we discuss the main challenges and
opportunities that s-Health would imply and
M. Conti is with the Uni- provide a common ground for further research.
versity of Padua.
INTRODUCTION
I. S. Vlachos and D. N.
Perrea are with LESSR, The adoption of information and communication
Medical School of technologies (ICT) within the healthcare sector
Athens. led to the concept of electronic health (e-health),
which is contributing to reduced costs and
V. Ramos is with Instituto increased efficiency. Following the consolidation
de Salud Carlos III. of e-health, the generalized use of mobile devices
with positioning capabilities (e.g., smartphones)
F. Falcone is with Univer- opened the door to the idea of mobile health
sidad Pública de Navarra. (m-health), which could be understood as the
delivery of healthcare services via mobile com-
O. Postolache is with munication devices. m-Health has extraordinary
Instituto de Telecomuni- potential since it adds to the advantages of e-
cações/ISCTE-IUL, Lis- health all the benefits related to the ubiquity of
boa. mobile devices (i.e., global monitoring capabili-
ties, wide availability, and immediacy). Although
R. Di Pietro is with Uni- significant advances have been made, m-health is
versità di Roma Tre. still in its early stages and is evolving in parallel
to another very promising concept: smart cities,
1 http://www-03.ibm.com/ which are also founded on ICT and aim to tack-
innovation/us/thesmarter- le local problems, from local economy and trans-
city/index.html, portation to quality of life and e-governance.
http://www.cities.io/ Local governments are investing in ICT to
74 0163-6804/14/$25.00 © 2014 IEEE
equip their cities with technological infrastruc-
tures able to support ambient intelligence, and
foster social responsibility and respect for the
environment. In this sense, the opportunities for
smart cities are boundless, and companies such
as IBM and Intel are taking action to consoli-
date their leadership in this sector. They have
identified several important areas in which smart
cities will play a key role: public safety, energy
and utilities, economic development, education,
social services, and healthcare, among others.1
Smart cities are strongly based on sensors that
provide updated information about diverse vari-
ables, including temperature, humidity, allergens
concentration, pollution, traffic conditions, and so
on. According to Chen and Kotz [2], the context
could be defined as “the environmental states and
settings that either determine an application’s behav-
ior or in which an application event occurs and is
interesting to the user.” We understand these vari-
ables, provided by the smart city infrastructure, as
the context that helps us to understand the living
environment of a citizen at any time. Thus, by
properly using this information, we can provide
citizens and patients with healthcare applications
and services with active context awareness (i.e.,
applications and services that automatically adapt
to discovered context) by changing the applica-
tion’s and services’ behavior [2].
The main objective of this article is to coin
the concept of Smart Health (s-Health) as the
result of the natural synergy between m-health
and smart cities, from the ICT perspective as
well as that of individuals and society. We identi-
fy the main challenges and benefits implied by
the new concept of health within smart cities,
and discuss its feasibility in practice.
The rest of the article is organized as follows.
The next section summarizes the main research
fields that would play a key role in the develop-
ment of s-health. Next, we describe our notion
of s-health and emphasize its relevance, timeli-
ness, impact, and feasibility. In the following sec-
tion we elaborate on the main challenges and
opportunities that s-health implies. Finally, we
conclude the article by providing a summary of
our contribution and some final thoughts.
IEEE Communications Magazine • August 2014
SOLANAS_LAYOUT.qxp_Layout 7/30/14 2:00 PM Page 75
THE PIECES OF THE
S-HEALTH PUZZLE
s-Health is a natural complement to the concept
of m-health within the context of smart cities
that provide an extraordinarily rich context-
aware environment. Due to the fact that s-health
is a new concept, we can hardly analyze the state
of the art. However, we provide the reader with
a brief review of the main research areas related
to it.
SMART CITIES
The concept of the smart city has not been strict-
ly defined, and can still be considered a vague
idea. A definition of the concept is given by
Caragliu in [1] and extended in Pérez-Martínez
et al. [12] as follows:
“Smart cities are cities strongly founded on
information and communication technologies
that invest in human and social capital to
improve the quality of life of their citizens by
fostering economic growth, participatory gover-
nance, wise management of resources, sustain-
ability, and efficient mobility, whilst they
guarantee the privacy and security of the citi-
zens.”
Pérez et al. (2013) [12]
Smart cities are an imminent need, and have
recently received much attention from industry
and academia. Private companies like IBM,
Intel, and Siemens are investing in smart cities,
and the scientific community has started to ana-
lyze them in detail [11]. The latest reports show
that urbanization is progressing at an unprece-
dented pace. Currently, 50 percent of the world
population lives in cities, and this percentage is
expected to grow up to 70 percent by 2050. 2
Thus, the development of infrastructures to
address the needs of these huge amounts of peo-
ple is urgent. Moreover, big city infrastructures
need efficiency in many aspects, from energy
consumption to resource allocation. Therefore,
the only way for cities to provide sustainability
and a good quality of life to their citizens is
through “smart” interaction with them by using
ICT to guarantee access to context-aware infor-
mation.
Several cities have already started to work
toward the adoption of the concept. Amsterdam
has determined four areas (i.e., living, working,
mobility, and public space) around the idea of
sustainability, in which smart projects are con-
ducted in order to improve the city. In Amster-
dam, they focus on the reduction of CO 2
emissions, but we could find other examples that
focus on other aspects as well. 3 Some other
examples of cities pursuing “smartness” are
Vienna, Toronto, Paris, New York, London,
Tokyo, Copenhagen, Hong Kong, and Barcelona.
The widespread adoption of sensors within
smart cities provides additional interactions
through people-centric, participatory, and oppor-
tunistic sensing [8, 9]. In this context a smart city
becomes a huge system of systems, which has to
provide citizens and local authorities with the
processed information, in many cases personal-
IEEE Communications Magazine • August 2014
ized, that enables them to use the provided ser-
vices on request, to manage cities and create the Smart cities are an
momentum for corrective actions.
imminent need,
ELECTRONIC AND MOBILE HEALTH and have recently
With the promise of being helpful in addressing received much
open biomedical problems, ICT have attracted
the attention of the medical community. A col- attention from
lection of devices and complex systems with industry and
computers, sensors and databases are used in
academia. Private
the so-called electronic health (e-health), which
could be defined as: companies like IBM,
Intel, and Siemens
“an emerging field in the intersection of med-
ical informatics, public health and business, are investing in smart
referring to health services and information cities, and the
delivered or enhanced through the Internet and
scientific community
related technologies. In a broader sense, the
term characterizes not only a technical develop- has started to
ment, but also a state-of-mind, a way of thinking, analyze them
an attitude, and a commitment for networked,
global thinking, to improve health care locally, in detail.
regionally, and worldwide by using information
and communication technology.”
Eysenbach, 2001 [4]
ICT might be used for a variety of health-
related tasks, including communication between
patients, doctors, and carers; distant provision of
care; remote support to electronic diagnostic
medical records; medication adherence control,
and so on. ICT in the healthcare sector, if prop-
erly used, can significantly contribute to the
reduction of management costs and increased
efficiency. In this line, e-health substantially
reduces the displacement of professionals and
patients, globally brings down the cost of medi-
cal resources, and makes treatment and health
watchfulness more comfortable to patients. All
in all, e-health might be considered a revolution
in this area. However, a probably more impor-
tant revolution is taking place due to the use of
mobile devices (e.g., smartphones): mobile
health (m-health), which could be defined as the
discipline founded on the use of mobile commu-
nication devices in medicine or, more specifical-
ly, the delivery of healthcare services via mobile
communication devices; or:
“emerging mobile communications and net-
work technologies for healthcare systems”
Istepanian et al., 2006 [5]
The use of mobile devices helps to perform
tasks more efficiently. The remote monitoring of
patients and communication between profession-
als, relatives, and patients will especially benefit
from m-health. m-Health redefines healthcare
services in three main aspects:
• It allows easy access to an unprecedented
number of services and knowledge.
• It can be user-oriented.
• It can be personalized.
m-Health clearly extends the capabilities of 2 http://esa.un.org/unup
indoor monitoring environments, and it is a pow-
erful tool that allows the advance of several lines 3 http://www.ibm.com/
of research, such as the continuous assessment smarterplanet/us/en/
of the state of patients, early detection of emer- traffic_congestion/
gency situations, detection of changes in health nextsteps/solution/
conditions, detection of abnormal situations, and G080151O85496M88.html
75
SOLANAS_LAYOUT.qxp_Layout 7/30/14 2:00 PM Page 76
e-Health
m-Health s-Health
3 4
5 could be seen as an invasion of privacy, and it
h
Healt
1 2
s-Health
t city
4
5 tocols mainly based on public key cryptography
Smar
Figure 1. Set diagram for the health and smart city planes. The relation/pro-
jection/intersection between the two planes is represented as the area of
s-Health, and the numbers refer to the examples given within the text.
early detection of fragile situations. For the most
recent advances on e-health and m-health the
interested reader can refer to [14].
BRIEF SUMMARY OF RELATED RESEARCH AREAS
In the following, we list some representative
areas related to s-health. As a matter of fact, it
cannot be comprehensive. Notwithstanding, it is
intended as an overview of areas that interweave
within the context of m-health and smart cities
to contribute to the concept of s-health.
Cloud Computing and Distributed Sys-
tems — The emergence of mobile devices has
made millions of people turn to cloud-based
services. Infrastructure as a service (IaaS), plat-
form as a service (PaaS), and software as a ser-
vice (SaaS) have become common jargon. The
reason behind this shift is the need for seamless
syncing of contacts, calendar events, emails,
multimedia, and all kinds of data within a het-
erogeneous environment comprising different
devices, operating systems and applications.
Using cloud and distributed systems might help
diminish costs of software and hardware mainte-
nance as someone else handles the infra-
structure. Using cloud services and distributed
systems is paramount for mobile health and
smart cities since a wide variety of devices have
to coexist in a very heterogeneous environment.
Hence, they will also be of great importance for
the new concept of s-health.
Sensor Networks, Body Area Networks,
and Their Interoperation — A key element to
provide s-health in a personalized way is the
possibility of gathering multiple data from
patients and the environment. Due to their flexi-
bility, wireless systems are ideal candidates to be
the communication medium from the users to
the infrastructure, as well as among infrastruc-
tures. However, due to the great variety of net-
work technologies, it is very difficult to
interoperate them; also, during the deployment
phase, it is paramount to avoid radio-electric
interference and the like.
76
Privacy Protection and Security — Privacy is
a fundamental right that has to be guaranteed.
Within the healthcare sector, privacy issues are
even more apparent than in other contexts. For
example, the continuous monitoring of patients
must be carefully considered in order to stop
patients refraining from using that monitoring.
Private information retrieval and anonymization
techniques will play a key role in s-health.
Computer systems use passwords to identify
and authenticate people. In order to gain securi-
ty in the process of authentication, security pro-
have been widely used. In addition, biometric
features (iris, fingerprints, ECG, etc.) are gradu-
ally being adopted. Also, technologies such as
radio frequency identification (RFID) are used
for identification of physical objects and people.
Secure identification and authentication will be
paramount for our s-health concept.
Other Related Fields — In addition to the
aforementioned areas, the following are also relat-
ed to the concept of s-health. A description of
each area is beyond the scope of this article. How-
ever, for the sake of completeness we enumerate
them: remote patient monitoring and supervision;
data mining and knowledge discovery; information
systems; databases and big data; trust and interop-
erability; telemedicine; ambient assisted living; and
cloud storage security and privacy.
SMART HEALTH
We are coining the concept of smart health as
the natural complement of mobile health in the
context of smart cities. We are witnessing how
advances in ICT are being leveraged by the
healthcare sector to create m-health, and by local
and regional governments to foster the deploy-
ment of so-called smart cities. We can observe
these two trends toward the adoption of m-health
and the generalization of smart cities. Due to the
fact that these two concepts are studied indepen-
dently and deserve attention in their own rights,
they have rarely converged into common points
of contact. However, we claim that the infra-
structure and technologies of smart cities could
be leveraged and mixed with the concepts of m-
health and telemedicine to create a novel and
richer ubiquitous concept: smart health.
Figure 1 represents our concept of smart
health. We distinguish two planes, the health
plane and the smart city plane. Although those
planes seem to be independent, when we logical-
ly project one over the other we observe an
intersection that represents the provision of
healthcare services with the infrastructure of a
smart city. From this view we can derive the fol-
lowing definition for smart health:
“Smart health (s-health) is the provision of
health services by using the context-aware net-
work and sensing infrastructure of smart cities.”
According to this definition, smart health is a
subset of e-health since s-health is based on the
ICT infrastructure of a smart city. However,
IEEE Communications Magazine • August 2014
SOLANAS_LAYOUT.qxp_Layout 7/30/14 2:00 PM Page 77
1 2
Figure 2. Illustration of the examples of different kinds of health within the context of a smart city. Numbers refer to the subsets
depicted in Fig. 1.
smart health is different from m-health in the
sense that the used underlying infrastructure
might not be mobile at all; in fact, in many cases
it might consist of fixed sensors. With the aim of
clarifying the above concepts, let us refer to the
following examples depicted in Fig. 2, which
refers to the subsets illustrated in Fig. 1:
Example 1 — Classical health. This is a typi-
cal health-related activity, that is, a doctor visit-
ing a patient with traditional tools (which do not
necessarily involve ICT).
Example 2 — e-Health. This involves the use
of electronic health records (EHR) and databas-
es that store medical information of patients.
This is a subset of classical health that uses ICT.
Example 3 — m-Health. An example is a
patient checking her prescriptions from her
mobile phone to guarantee medication adher-
ence. This is a subset of e-health since it uses
mobile devices to access medical data.
Example 4 — s-Health. A patient gets infor-
mation from an interactive information pole to
check the pollution level as well as the level of
pollen and dust for which he has allergies.
Thanks to this information, the patient can avoid
areas that could be dangerous for his health con-
dition. The information pole informs him about
the best route to go, and where the closest phar-
macies are to buy antihistamine pills.
Example 5 — m-Health augmented with s-
Health. A cyclist wearing a bracelet with
accelerometers and vital constants monitoring
capabilities has an accident. The body sensor
network detects the fall and sends an alert to the
city infrastructure. When the alert is received by
the system, the conditions of the traffic are ana-
lyzed, and an ambulance is dispatched through
the best possible route. In addition, the traffic
lights of the city are dynamically adjusted in
order to reduce the time needed by the ambu-
lance to reach the cyclist.
All in all, the main goal of smart health is to
promote health to a higher position within soci-
ety in a distributed, private, secure, efficient, and
sustainable way by reusing the principles of m-
health and smart cities in a convergent new
paradigm of ubiquitous health.
IEEE Communications Magazine • August 2014
3 4 5
Pollution
With the definition and consolidation of the
new concept of s-health, we allow the extension
of the coverage of health from hospitals and
adapted homes to everywhere in the city. Also,
we provide the ground for the development of
new techniques, models, interactions, and syner-
gies that will contribute to the reduction of
health costs, increased quality of life of patients,
early detection of illnesses, collection of invalu-
able data for research, and the global improve-
ment of our society as a whole.
RELEVANCE AND TIMELINESS
The increasing average age of people and the
rise of chronic diseases will result in a dramatic
growth in the need for assistance and healthcare
within the years to come, especially in metropoli-
tan areas where there is a higher concentration
of inhabitants. There is an increasing demand
for outpatient care, maintaining and restoring
health, as well as maximizing the independence
of patients and their relatives. Improvements in
medical technology have helped people to live
longer and with a better quality of life. Notwith-
standing, our societies are faced with new social
and economic challenges due to the high expens-
es of welfare systems, and the increasing number
of elderly and chronic patients. In the near
future healthcare provision will change from
centralized healthcare services, provided by doc-
tors’ offices and hospitals, to health monitoring
based on ubiquitous and pervasive services. This
evolution has two causes. First, there is increas-
ing demand for better, more comprehensive and
proactive healthcare, whose key component is
the early-stage diagnosis of health issues provid-
ed by long-term and unobtrusive monitoring.
Second, there is a need to mitigate the increas-
ing healthcare expenses.
By providing health services in patients’
homes, not only may the expenses decrease, but
also, patients are provided with better quality of
life. In addition, with the new concept of s-
health, patients will also be monitored when they
leave their homes using the infrastructure of the
smart city, and new data will be gathered for
their benefit and that of society.
77
SOLANAS_LAYOUT.qxp_Layout 7/30/14 2:00 PM Page 78
S-HEALTH VS. M-HEALTH
The concept of
The concept of s-health could be considered an
s-health could be augmentation of m-health with the sensing capa-
considered an bilities of smart cities. Actually, there are signifi-
augmentation of cant differences between them that justify the
adoption of the new concept. While it is clear
m-health with the that the concept of s-health cannot be confused
sensing capabilities with that of smart cities, the differences with m-
health must be highlighted. The main difference
of smart cities. are the following.
Actually, there are Differences in information sources: The data
significant used in m-health come from the patients. How-
ever, in the s-health approach the data are not
differences between only from patients but from a completely inde-
them that justify pendent new source (i.e., the smart city sensing
infrastructure). This new source of information
the adoption of surpasses m-health and justifies the appearance
the new concept. of the new concept of s-health.
Differences in information flows: m-Health is
personalized (user-centric), while s-health is not
only user-centric but also city-centric. This
means that in m-health, data are collected from
patients and processed, and the results go back
to patients. However, s-health is not only user-
centric but also city-centric since the information
gathered by the patients also modifies the behav-
ior of the city. For instance, in example 5, the
fall of the cyclist changes the behavior of the city
and leads to the modification of the traffic lights
that allows the easiest arrival of an ambulance
(clearly, this is beyond the scope of m-health).
IMPACT AND FEASIBILITY
s-Health focuses globally on society since every-
one will become a patient during their lifetime,
and we all participate in healthcare costs. In
addition, we believe that it is important to define
and clarify this concept now to drive the efforts
of the diverse research communities toward a
common and well defined concept of health
from the very beginning of its development, thus
averting unnecessary duplication and overhead
in the future.
The concept of s-health is groundbreaking by
its very nature and will result in a clear step for-
ward. The proposed concept will have an impact
in many senses.
For society. The generalization and adoption
of the concept of s-health will benefit society as
a whole. Improving healthcare services con-
tributes to the creation of a healthier society,
with healthier habits related to proper nutrition
and physical activity within the sustainable and
green philosophy of smart cities. Patients will
greatly benefit from the concept of s-health since
they will gain quality of life and independence,
while their treatments become more efficient
and cheaper. Also, we believe that s-health could
contribute to the reduction of morbidity and
mortality rates.
For governments. The adoption of the model
of s-health we are proposing might significantly
help reduce healthcare costs. Thanks to early
detection and prevention mechanisms, patients
will require fewer treatments. In addition, by
using the infrastructure of smart cities, unneces-
sary duplicities are reduced, and deployed sys-
tems will be more efficiently used.
For research. The infrastructures and the
78
concept of s-health along with the big data and
cloud storage/computing paradigms will allow
the gathering of unprecedented amounts of data.
These data are invaluable for the scientific com-
munity, which would be able to run experiments
to gain knowledge on a variety of fundamental
areas of human behavior, healthcare, engineer-
ing, and so on.
Regarding feasibility, the concept of s-health
is a natural outcome of the mixture of well-
known areas. Society has already accepted the
concepts of m-health and smart cities; thus, it
seems to be prepared to also embrace s-health.
CHALLENGES AND OPPORTUNITIES
CHALLENGES
The concept of s-health comprises a bewildering
set of research areas that generally work inde-
pendently. The adoption of the s-health
paradigm by citizens requires the fulfillment of
technological, financial, logistic, and psychologi-
cal requirements [13]. The following is an indica-
tive list of the main challenges that we envisage
s-health will have to overcome.
Multidisciplinary Research and Interaction
— All the areas described above are being stud-
ied worldwide by researchers and practitioners.
However, it is pretty unusual for those
researchers to work in the same institution; thus,
it is much more difficult for them to share their
knowledge to lead to interdisciplinary solutions
such as the concept of s-health. Since this idea is
new, there is a need for interaction and collabo-
ration among many actors (governments,
researchers, physicians, practitioners, etc.) to
define common ground from the very beginning,
thus avoiding unnecessary redesigns and over-
spending.
Security and Privacy — Although s-health
might help to mitigate many health-related
issues, its ability to gather unprecedented
amounts of information could endanger the pri-
vacy of citizens. Protecting privacy and securing
the infrastructure is an inescapable challenge the
research community is still struggling to address.
Security and privacy protection is essential in
almost every aspect of our lives. However, in the
context of a smart city, it is even more important
due to the fact that the gathered information is
highly personal. From the data collected in a
smart city, it would be possible to infer citizens’
habits, their social status, and even their religion.
All these variables are very sensitive, and when
they are combined with health information, the
result is even more delicate. Thus, it implies a
great challenge that is still to be studied in
detail. Some attempts have been done to define
the concept of citizen privacy and to provide
ways of protecting it [10]. Also, many efforts are
devoted to the protection of privacy in health; a
representative project in this direction is Trust-
worthy Health and Wellness (THaW) [7]. THaW
is aimed at solving several challenges to provide
trustworthy information systems for health and
wellness. Similarly, the Strategic Healthcare IT
Advanced Research Projects on Security
(SHARPS) project 4 aims at advancing the
IEEE Communications Magazine • August 2014
SOLANAS_LAYOUT.qxp_Layout 7/30/14 2:00 PM Page 79
requirements, foundations, design, development
and deployment of security and privacy tools and
methods for m-health. Those projects are in the
edge of research and their challenge is
formidable.
Sensor Integration— One of the main chal-
lenges in the implementation of scenarios in
which ambient intelligence is supported, is to
adequately account for the co-existence of het-
erogeneous systems. The system performance
has a clear topological and morphological
dependence from the location at which it oper-
ates. This last statement holds especially true in
the case of dense urban locations, in which the
main radio-electric phenomena are given by
multipath propagation. In the case of body area
networks [6], an additional element of complexi-
ty is added due to the presence and impact of
the human body in the wireless channel. Also,
privacy issues in the urban sensing ecosystem
are a further research issue, only partially
addressed thus far [3].
Big Data Management and the Cloud —
Big data is generally defined by the 3Vs: variety,
velocity, and volume. In a smart city these 3Vs
are especially important, and they are even
more relevant in the context of smart health.
The data collected from the sensors are very
diverse: temperature, pollution, allergens, and
so on (variety); these data must be collected and
analyzed almost in real time to provide a useful
service to citizens/patients (velocity); and the
amount of collected data is huge since thou-
sands of sensors take measurements every few
seconds (volume). The huge amount of data
that are collected in real time pose a tremen-
dous problem in both bandwidth and storage. A
possible way to approach this problem is by
embracing the cloud paradigm. However, it is
not straightforward to implement this solution
since its scale has many implications for privacy,
security, multi-tenancy, access control, and so
on. In addition, the mining and analysis of this
humongous amount of data is also a tremen-
dous challenge for the artificial intelligence and
statistics communities.
Usability and Human–Computer Interac-
tion— How citizens interact with the city is an
open issue to be solved. There are many prob-
lems to be addressed, such as designing better
wearable and unobtrusive sensors, improving
compactness and weight, increasing autonomy,
simplifying interaction processes, making person-
alization easier, and improving reliability. Solv-
ing these issues is essential for the success of
both smart cities and s-health.
Others— In addition to the above, Postolache
et al. [13] identified other challenges in the
adoption of pervasive healthcare: financial con-
straints, underestimation of the complexity of
the technological challenges, organizational
issues, collaboration among all stakeholders (i.e.,
patients, doctors, therapists, sociologists, engi-
neers, computer technicians), and the definition
of proper quality audit processes and cultural
aspects.
IEEE Communications Magazine • August 2014
OPPORTUNITIES
The concept of
The concept of s-health is founded on the use of
the infrastructure of smart cities, which opens a s-health comprises a
wide range of opportunities for the development bewildering set of
of new health-related applications and services. research areas that
The following is an indicative list aimed at illus-
trating the potential of s-health. generally work
independently. The
Data Collection, Presentation, and Analysis
— Health-related data collection could be prac- adoption of the
tically redesigned, since information, which s-health paradigm by
nowadays is not considered, might become cen- citizens requires the
tral to the provision of cutting edge health ser-
vices. Real-time data could be collected from/by fulfillment of
patients and healthy individuals, and combined technological,
with city data. Citizens’ vital signs, routes, and
health records could seamlessly be integrated financial, logistic,
with data derived from ubiquitous sensors, cam- and psychological
eras, weather reports, and forecasts. Proper use requirements.
of such data could become the pillar of s-health
applications.
Prevention and Management of Critical
Incidents— s-Health will allow the accurate
prevention and efficient management of chronic
and acute diseases and accidents. Comprehen-
sive s-health data can be used to identify situa-
tions requiring intervention (e.g., cardiovascular
events, falls, accidents), and provide automated
and optimized management of each incident,
including provision of guidance and notification
to authorities (Example 5). In the case of a mild
incident, the patient could be guided to the
nearest pharmacy or healthcare provider, while
in life threatening situations, traffic information
could be used to dispatch and guide ambulances.
Comprehensive analysis of gathered data could
provide multiple means for more efficient dis-
ease prevention, earlier detection of chronic ill-
nesses, and even the identification of novel
health threats and risk factors.
Effectiveness and Environmental Assess-
ment — Patient monitoring data can be utilized
to identify non-optimally managed cases or non-
responsive patients to a given treatment and
provide efficient assistance. For instance, s-
health systems could identify chronic patients
with vital signs contradictory to their prescribed
medication (abnormal heart rate, blood pres-
sure, blood glucose, etc.). Such data can be com-
bined with a patient’s status, location, and
current activities in order to reduce false posi-
tives and identify bona fide events requiring
intervention. These applications might also have
a significant impact on the assessment of novel
interventions in clinical trials. s-Health systems
could seamlessly integrate long-term patient
monitoring, medical records, and efficiency
assessment methodologies with city sensors’
data. This integration renders an optimal setting
for the provision of high-quality personalized
medicine. Environmental conditions (tempera-
ture, pollution, humidity, etc.) and patients’ daily
routes and activities could be used to fine-tune
dosing at an unprecedented level of detail, while
the ability of the system to actively and routinely
assess the effectiveness of each intervention
could practically maximize all benefits. 4 http://sharps.org/
79
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Engaging Patients and Families in Manag-
While researchers are ing Their Health — In s-health, the citizens
are significantly empowered and efficiently
already shaping our assisted in order to actively participate in man-
future according to aging their health. s-Health systems can utilize
medical records data and vital signs in order to
the established con-
provide optimal guidance for activities, habits,
cepts of smart cities and everyday tasks within the city. For instance,
and m-health, we an s-health application could provide patients
with heart or respiratory problems with an opti-
believe that there is mal route by avoiding areas with high atmo-
a need for a new spheric pollution levels.
concept to which we
Improving Policy Decisions — s-Health sys-
refer as smart health tems could facilitate public health management.
(s-health), emerging Policies and decisions can be “personalized” to
each city and even district, based on data derived
from the combina- from population, health hazards, environment,
tion of smart cities climate, and available infrastructure. The oppor-
with electronic and tunities arising from mining such data in order
to optimize public health decision making are
mobile health boundless.
services.
Epidemic Control — s-Health data and
methodologies can also drastically increase our
efficiency in detecting and controlling epidemics.
Citizens’ vital signs, locations, and activities
could be used to detect probable new cases dur-
ing an epidemic, efficiently identify areas of
increased risk, and optimally manage a raging
epidemic. Such methodologies can also be
applied to the detection and management of
other extensive health risks (e.g., pollution or
radiation from an industrial accident).
Cost Saving — All the previously analyzed sec-
tors might have a significant impact on health-
care cost reduction. Such reduction will also be
accompanied by an increase of system efficiency
and improvement of provided services. Timely,
optimized disease management and prevention
can lead to a reduction of unnecessary hospital
visits and the emergence of acute events from
poorly managed chronic patients. In addition,
reduced time for action and efficient public
health management could also provide optimal
results while presenting cost reduction on a
nation-wide scale.
CONCLUSION
The widespread adoption of ICT in the context
of cities has led to the appearance of smart
cities. Similarly, the use of ICT and mobile tech-
nologies for health-related issues ended up with
the provision of patient monitoring and health-
care in a pervasive way through electronic and
mobile health. While researchers are already
shaping our future according to the established
concepts of smart cities and m-health, we believe
that there is a need for a new concept to which
we refer as smart health (s-health), emerging
from the combination of smart cities with elec-
tronic and mobile health services.
By coining this new concept and clarifying its
scope, we are paving the way for future research
to have a clearer focus and a common ground to
improve healthcare as a whole. In this article we
introduce the new concept of s-health, review its
most related research fields, discuss the main chal-
80
lenges for its implementation and development,
and highlight the possible implementation oppor-
tunities that s-health might imply in the near
future, which we believe are almost boundless.
ACKNOWLEDGMENT
When this article was written Agusti Solanas was
partly supported by a “Visiting Scientist 2012-2013”
grant funded by the University of Padua, Italy.
Agusti Solanas and Antoni Martínez-Ballesté
are with the Smart Health Research Group in
the Department of Computer Science and Math-
ematics of Rovira i Virgili University and are
partly funded by “La Caixa Foundation” through
project “SIMPATIC: Intelligent, Autonomous
and Private Monitoring System based on ICT” -
RECERCAIXA’12 and by the Government of
Catalonia under grant 2009 SGR 1135.
Mauro Conti was supported by a Marie Curie
Fellowship, for the project “PRISM-CODE: Priva-
cy and Security for Mobile Cooperative Devices”
funded by the European Commission (grant n.
PCIG11-GA-2012-321980), and by the PRIN pro-
ject “TENACE: Protecting National Critical
Infrastructures From Cyber Threats” (grant n.
20103P34XC) funded by the Italian MIUR.
Octavian Postolache is partially supported by
Instituto de Telecomunicações and Fundação
para a Ciẽncia e Tecnologia (project PTDC/
DTP-DES/1661/2012).
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IEEE Communications Magazine • August 2014
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BIOGRAPHIES
AGUSTI SOLANAS [M’04] is head of the Smart Health Research
Group and an associate professor in the Department of
Computer Engineering and Mathematics at the Rovira i Vir-
gili University (URV) of Tarragona, Catalonia, Spain. He
obtained his B.Sc. and M.Sc. degrees in computer engi-
neering from URV in 2002 and 2004, respectively, the lat-
ter with honours (Outstanding Graduation Award). He
received a Ph.D. in telematics engineering from the Techni-
cal University of Catalonia in 2007 with honours. His fields
of activity are mobile health, smart health, data privacy,
ubiquitous computing, clustering, pattern recognition, evo-
lutionary computation, and artificial vision. He has
authored over 100 publications. He has served as Chair,
Programme Committee member, and reviewer for several
conferences and journals. He has served as an external
reviewer for the Romanian National Council for Scientific
Research. He is a member of the Association for Comput-
ing Machinery (ACM).
C ONSTANTINOS P ATSAKIS is a lecturer in the Department of
Informatics, University of Piraeus, Greece. He received his
B.Sc. in mathematics from the University of Athens,
Greece, and his M.Sc. in information security from Royal
Holloway, University of London. He also received a Ph.D.
from the University of Piraeus. His main areas of research
include cryptography, security, privacy and number theory.
He has participated in several research and development
European-funded projects. He has taught several computer
science courses in Greek and Catalan universities. In the
past, he worked as a researcher at the CRISES Research
Group and the UNESCO Chair in Data Privacy in the Depart-
ment of Computer Science and Mathematics at URV and as
a research fellow at the Distributed Systems Group, Depart-
ment of Computer Science, Trinity College, Dublin, Ireland.
MAURO CONTI [SM] obtained his Ph.D. from Sapienza Uni-
versity of Rome, Italy, in 2009. After his Ph.D., he was a
postdoctoral researcher at Vrije Universiteit Amsterdam,
The Netherlands. Since 2011, he is an assistant professor at
the University of Padua, Italy. He has been a visiting
researcher at GMU (2008), the University of California at
Los Angeles (UCLA) (2010), UCI (2012, 2013), and TU
Darmstadt (2013). He has been awarded a Marie Curie Fel-
lowship (2012) by the European Commission, and a Fellow-
ship from the German DAAD (2013). His main research
interest is in the area of security and privacy. In this area,
he has published more than 70 papers in international
peer-reviewed journals and conferences. He was a Panelist
at ACM CODASPY 2011 and General Chair of SecureComm
2012 and ACM SACMAT 2013.
IOANNIS S. VLACHOS received his B.Sc. from the Department
of Informatics, University of Piraeus, and his M.Sc. in Bioin-
formatics from the Department of Informatics and Telecom-
munications, University of Athens. He worked as a lecturer
from 2007 to 2012 at the Laboratory for Experimental
Surgery and Surgical Research, Medical School of Athens.
Since 2011 he is also part of DIANA-lab, BSRC, and Flem-
ing. His research focus is biomedical data analysis, bioinfor-
matics, and machine learning. He has 12 awards for best
presentation, scholarships, and distinctions in international
competitions. He has 43 publications in peer-reviewed jour-
nals and more than 80 congress announcements. His publi-
cations have been cited more than 400 times.
V ICTORIA R AMOS [M’90] received her Ph.D. in biomedical
Engineering and telemedicine from the University of Alcala,
Madrid, Spain, in 2005. Since 1996, she has been a
research scientist, and now she is a tenured scientist OPI at
the Health Institute Carlos III in the Research Area of
Telemedicine and e-Health in Madrid, Spain. Her research
focuses on the area of wireless communications applica-
tions for home care and telemedicine applications focusing
on new emergent health services. It involves standards
related to human exposure, medical devices immunity, and
radio communication EMC. She takes part in several Euro-
pean and Spanish standardizations committees.
FRANCISCO FALCONE [M’05, SM’09] received his telecommuni-
cations engineering degree (1999) and Ph.D. in communi-
cations Engineering (2005), both from the Universidad
IEEE Communications Magazine • August 2014
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Publica de Navarra (UPNA) in Spain. From 1999 to 2000 he
worked as a microwave commissioning engineer at
Siemens-Italtel. From 2000 to 2008 he worked as a radio
network engineer in Telefónica Móviles. In 2009 he co-
founded Tafco Metawireless. From 2003 to 2009 he was
also an assistant lecturer at UPNA, becoming an associate
professor in 2009. His research area is artificial electromag-
netic media, complex electromagnetic scenarios and wire-
less system analysis. He has over 350 contributions in
journal and conference publications. He was the recipient
of the CST Best Paper Award in 2003 and 2005, Best Ph.D.
in 2006 awarded by the Colegio Oficial de Ingenieros de
Telecomunicación, Doctorate award 2004–2006 awarded
by UPNA, Juan Lopez de Penalver Young Researcher Award
2010 awarded by the Royal Academy of Engineering of
Spain, and Premio Talgo 2012 for Technological Innova-
tion.
O CTAVIAN A DRIAN P OSTOLACHE [M’99, SM’06] graduated in
electrical engineering at the Gh. Asachi Technical University
of Iasi, Romania, in 1992, and received his Ph.D. degree in
1999 from the same university. In 2000 he became a prin-
cipal researcher of Instituto de Telecomunicações, and an
assistant professor of EST/IPS Setubal and ISCTE-IUL Lisboa
in 2001 and 2012, respectively. He is the founder and lead-
er of the Pervasive Sensing and Computing research group.
His fields of interest are smart sensors, and pervasive sens-
ing and computing. He is author and co-author of 9
patents, 7 books, 14 book chapters, 61 peer reviewed
papers in international journals, and more than 200 papers
in proceedings of international conferences. He is an ACM
professional member, Chair of IEEE MeMeA 2014, Techni-
cal Chair of ICST 2014, and an Associate Editor of IEEE
Sensors Journal. He received the IEEE I&M outstanding
reviewer and IEEE Best Associate Editor Awards.
PABLO A. PÉREZ-MARTÍNEZ is a Ph.D candidate at the CRISES
Research Group and the UNESCO Chair in Data Privacy in
the Department of Computer Science and Mathematics at
URV. He obtained his B.Sc. degree in computer science
from the University of Lleida and his M.Sc. in computer sci-
ence and security from URV. His main fields of interest are
privacy and security in location-based services.
ROBERTO DI PIETRO [M] is an assistant professor in computer
science at Università di Roma Tre, Italy. His main research
interests include security and privacy for wireless systems,
cloud and virtualization security, security and privacy for
distributed systems, applied cryptography, computer foren-
sics, and role mining for access control systems. He has
published more than 150 scientific contributions in these
topics, receiving more than 3200 citations. He was award-
ed a Chair of Excellence (2011–2012) from University Car-
los III, Madrid. He is a member of ACM and the IEEE
Computer Society.
D ESPINA N P ERREA received her B.Sc. from the Chemical
School of the University of Patra (1973) and Ph.D. from
Athens Medical School (1982). From 1982 to 1990, she
was a lecturer at the Department of Experimental Surgery
and Surgical Research of Athens Medical School. In 1990
she became an assistant Professor; in 1998 she was made
an associate professor; and in 2010 she became a full
professor. She has directed the laboratory since 2000. Her
research focus includes experimental pathobiochemistry,
nutrition, atheromatosis, diabetes, metabolic syndrome,
and research protocols using animal models. She has par-
ticipated in more than 40 research programs both nation-
ally and internationally funded. She has more than 200
articles in peer-reviewed journals, 10 letters in indexed
journals, and 223 chapters in books/congress publica-
tions.
ANTONI MARTÍNEZ-BALLESTÉ is a tenured assistant professor in
the Department of Computer Science and Mathematics at
URV). He received his M.Sc. degree in computer engineer-
ing from URV in 2002. He obtained his Ph.D. in telematics
engineering from Universitat Politécnica de Catalunya in
2004 with honours. His research interests include security
and privacy aspects of information and communications
technologies and their users, specifically privacy in video
surveillance. He is also interested in e-health. He has
authored over 70 publications.
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