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Innovative Open-Source Platform for Seamless Healthcare Device Marketing and Configuration

Final Report Summary - CARESTORE (Innovative Open-Source Platform for Seamless Healthcare Device Marketing and Configuration)

Executive Summary:
One of the main objectives of the CareStore project was to develop, test and launch a novel open source ambient assisted living platform – to the benefit of its primary users and to strengthen the SME partners in its business side and know-how. As such, CareStore has gone far. Already well into testing the platform with multiple users alongside business developing a cost-effective management of assisted living technologies and patient healthcare. With advanced performance and significant benefits compared to currently available state of the art systems to follow.

Once the prototypes have been further developed and refined in the market-like situation and tests at the German nursing home, where the CareStore solution is currently up and running, the CareStore platform helps increase the effectiveness of the staff with regards to the deployment of new devices and applications, as well as reducing the need for manual reporting of workflow tasks during daily routines, with potential cost savings and efficiency improvements to follow.

The coming years will show if the consortium SMEs are able to attract considerable interest from third party companies within the healthcare sector. If so CareStore, allowing third party vendors to easily access and publish new devices and applications to Sekoia’s existing base of touch screen platforms, will help staff and inhabitants to achieve a greater output of the devices existing in the local eco system. Hence benefitting from a wide array of technologies that today at best are used pro forma, and in the future can be installed, used and connected to other devices and hubs without requiring technical staff intervention.

Project Context and Objectives:
CareStore set out to create a shared and open online platform, a marketplace similar to commercial counterparts such as Google Play and Apple AppStore, for easier and a more valuable deployment of applications and devices within the healthcare domain. The consortium has undertaken a huge research effort investigating how to extend a reliable and secure recognition and identification hardware and software platform to make it work in a commercial pan-European context. Also, the research was followed by state-of-the-art development efforts across the entire consortium. A consortium that has worked closely together to reach a common goal.

The three major subsystems of CareStore, Common Recognition and Identification Platform (CRIP), Common Ambient Assisted Living Home Platform (CAALHP), and the CareStore Marketplace, was successfully designed, implemented, tested, integrated, and are functional at the SSRG test site as detailed in the DoW and overall requirement specification. Also, as a major goal, the Sekoia Platform was successfully integrated with the CareStore system mainly through the CAALHP, allowing communication and security events, and monitoring to be utilized. Likewise, a range of commercial medico and assisted living devices has been integrated and tested with CareStore, alongside research prototypes.

Today, a large number of assisted living technologies co-exist without a common language between them. They have different user interfaces, communication infrastructures, and maintenance plans, which limit the inclusion of efficiency-enhancing solutions in the homecare and elderly sector. The deployment of applications and devices is overly complex, and cannot be handled by the healthcare staff or citizens themselves, but require support from technical personnel, thus increasing cost and reducing feasibility of implementing new technology solutions.

By developing a strong CareStore platform, based on standardized user-interface and recognition technology where all technologies and devices can be seamlessly installed and connected, we would most likely increase the incentive to implement assisted living technologies in the homecare and elderly sector. Thus opening up a significant market potential for the SME consortium and favor the general common good of all stakeholders involved.

The clear objective from day one – and really a long time before this – has been to promote and develop a healthcare solution so likeable to its users that it will be feasible enough for other players in the market to go this way, not only creating a small local impact, but a greater European change of attitude, providing a new best practice.

Project Results:
Based on a thorough demand and requirement specification phase, the CareStore project has delivered some essential findings for the involved partners. Divided into three main S&T areas, the findings include software and hardware components.

The CAALHP (Common Ambient Assisted Living Home Platform) is an intelligent unit in the citizen home at any typical kind of care home, where different technologies interoperate to help nursing home staff provide a better and more efficient care work.

The CRIP (Common Recognition Identification Platform) is a user recognition and communication platform between users, hardware and software. The CRIP simplifies the interaction between the users and other technological platforms by integrating RFID and NFC identification technologies, IP (Internet Protocol) and Bluetooth communication technologies.

The CareStore Marketplace is a niche app and devices store for healthcare solutions that enable a much faster and cost-efficient deployment of new technologies.

Common Ambient Assisted Living Home Platform
Although the name it self may repel a few up and coming developers, the CAALHP is in fact quite straightforward. The subsystem was analyzed, specified, designed, implemented, tested and documented following state-of-the-art methods and best practices. It has run on a target touch screen machine during its three main iterations and more than 200 official builds for more than a year at the Ambient Assisted Living Lab at Aarhus University, including testing with various medico and AAL devices and prototypes. It has also been installed at our RTD and SME partners’ office sites, until it was finally deployed at the project test site in Glücksburg, Germany at the nursing home "Senioren Residenz Glücksburg".

The CAALHP works with the two other subsystems, as well as the Sekoia platform, which runs as a CareStore application. This means that the Sekoia platform application may benefit from all the features found in CAALHP, including access to Marketplace and CRIP functionality.

To exemplify, a user logging in via biometrics or RFID on the CRIP platform will make a secure web service call to the CAALHP CRIP service, which in turn sends an event via its middle-ware communication bus. All apps listening to the “UserLoggedIn” event, including the Sekoia app, will be notified and may use the results. Besides interoperating as specified in the DoW and the requirement specification with the CRIP and CareStore marketplace sub-components, the CAALHP has been tested with a range of medical devices and ambient assisted living applications from different vendors. Commercially available medical devices and gateways we have integrated with include A&D TM2655 BP, UA767NFC Blood Pressure Scale, UA767BT Blood Pressure Scale, UA767BTC Blood Pressure Scale, UC-321PBT Weight Scale, UC-321PBTC Weight Scale, UW-101NFC Activity Monitor, Nonin 9560 Pulse Oximeter, Omron HBF-206IT Weight Scale, Omron 708-BT Blood Pressure Monitor, Contextua Systems 4Nets Intel IEEE Health Hub. Several Ambient Assisted Living products have been prototyped (product development is planned), including CareBed sensor integration for Guldmann care beds, and Consulo infrared surveillance cameras for automatic video capture. For this purpose, a prototype monitor application has been developed to showcase CareStore. Also, we have integrated with the OpenHealth Personal Health Record system, the Net4Care Danish National HL7 Clinical Integration Project.

CAALHP is fully functional and may be used as an open source alternative to e.g. Android, Windows 8 Metro and iOS, including launching and interoperating heterogeneous applications, including applications written in Win32 C++, Python, Java, C#, Managed C++, and also supports communication with apps operating within a virtual machine on the host computer or on a network attached host. CAALHP uses either the ICE middle-ware and/or the System.AddIn framework for inter-communication between the separate processes, including to separate its own core processes, as well as the apps, services, and drivers that it hosts. It is easy to implement e.g. a REST based alternative paradigm. Currently CAALHP runs solely on Windows 7/8/Embedded platforms, but conversion to Linux has begun post-project using Mono, and is progressing well. The large amount of supported medico and AAL devices allows the CAALHP to be used in variety of applications.

There is a range of tutorials that will make it easy for third party developers to get involved. In fact, all that is required is a NuGet package link, or a static assembly .dll reference, and a third party application may interact with CAALHP, and from there, with the Marketplace, the CRIP, and the range of services, apps and drivers we have created, including from our large library from previous research and development activities.

Furthermore, the CareStore project have contributed to us achieving a high level of understanding of the standards in the area, the use of IEEE 11073, HL7, OpenEHR, and other standards. AU has published several papers in journals and conference papers on selected aspects of the development and evaluation process throughout the project period. The RTDs are now using the CareStore project as teaching material for courses on pervasive computing, pervasive healthcare, and AAL / smart home technology. This implies that the students are taught how to do CareStore applications as part of their curriculum.

Common Recognition Identification Platform
The CRIP proved to be a functional device as usability tests by the various partners proved, plus the hours that where spent by the development team testing it during the development and integration with the CAALHP subsystem, at the laboratories and on the Glücksburg nursing home. On the final stages of integration, the entire laboratory of University of Minho (around 15 persons) were registered on the CareStore platform and daily successfully recognized during a trial period of 3 months without any issues. This lab test proved to be important, since it mimic the final deployment scenario of the CareStore platform at the Glücksburg nursing home.

The medical devices recognition via Bluetooth proved to work , although some devices failed due to how these devices operate. It was assessed that the Bluetooth medical devices are developed for a one-person scenario, i.e. the device can only be paired with once, and that constrains the seamless idea of CareStore where, for example, a nurse uses the same device for collecting data from many users. This issues was reported to several manufacturers and the consortium is confident that new generations of Bluetooth medical devices will have support for multiple-person scenario.. So, with future technological outcomes on the medical devices, we are confident that CRIP will be a seamless platform to interact with them, providing an easy way for the users to operate the medical devices.

The Portuguese laboratory team gained practical experiences and better understanding of the standards in the area of Pervasive Healthcare technologies, such as the use of standards like IEEE 11073 and its usage by the Continua Alliance consortium, and other regulative, standards and know-how.

Together, the partners have published several papers in journals and conference papers on selected aspects of the development and evaluation process throughout the project period.

CRIP will also be used as a base platform for a PhD research work. This is possible because the CRIP design is flexible enough so it can be adapted to many healthcare scenarios, by easily adding new software and hardware technologies. Future work is a revamped hardware platform that enables adding new modules in an even simpler way, so that newer research projects can be rapidly developed over the CRIP base platform.

CareStore Marketplace
All services, devices and applications are hosted and administered in the marketplace. This subsystem has been specified, designed, implemented, tested and documented. All parties were later involved in integration of all subsystems, therefore necessary development tasks have been scheduled and performed in order to complete the deployment of the marketplace in Microsoft Azure cloud service.

The three major subsystems of CareStore were successfully integrated, and now works in conjunction at the SSRG test site as detailed in the DoW and overall requirement specification. Also, as a major goal, the Sekoia platform was successfully integrated with the CareStore system mainly through the CAALHP, allowing communication events and monitoring to be utilized. The technical integration occurs through the CareStore AppAdater library. The AppAdpater library is a Dynamic Link Library (.NET .DLL Assembly), which the Sekoia platform main application references and instantiates when it is part of CareStore.

Up and running
The consortium has tested the project results as developed through the sprints – to be continued and addressed in the post-project next steps. In that way the implementation has been the laboratory we wanted to create; close to reality testing with real users to see how they correspond using the CareStore, and with what potential barriers and benefits.

The test phase counts as a massive new starting point for the beneficiaries, both commercially with the SMEs and as a reference point for all involved RTDs. The test is still running at SSRG nursing home, collecting more information on optimal use and business model layout.

Potential Impact:
The technical project results have been disseminated through h various commercial and research focused channels. Covering from national radio shows to IEEE papers.

From the perspective of the well-known western world demographic challenge, a somewhat successful CareStore implementation can be seen as part of the global trend of digitalization of the entire elderly care. Once very little prioritized in terms of technological innovatin; nowadays very much in focus. CareStore as a concept writes another chapter within that theme, expectedly then leading to an improved quality of life and better business cases for the involved SMEs haresting the huge potential of the project S&T results.

As an example, the public Danish care sector represents a value of €16 billion per year, covering about 225,000 citizens, summing up to an average of €70,000 per person. Keeping people out of this sector does not eliminate costs altogether, as there is likely a need of care assistance, but looking at the potential savings of a nursing home can seem immense.

Consortium partner Sekoia has achieved municipal results of moving 33% time from nursing home offices to face-to-face time, by reducing the amount of paper work etc. Allowing the staff to focus on core tasks opens up for cost savings, slowly working its way into the above national and even European numbers. Especially when considering the fact that helping the care workers to a better routines also documents a decrease of unforced significant events by more than 50%, while also reducing sickness absence by 32% due to lowered stress levels among the staff – in that same Danish study. A business model is certainly at hand, while a stern and generic business case would require that the CareStore project results move into and stay in operation.

CareStore contact information:

Coordinator and Technical Manager: Stefan Rahr Wagner
Phone: +45 4189 3254
E-mail: sw@eng.au.dk

Project Manager: Morten Mathiesen
Phone: +45 2639 0197
E-mail: morten@sekoia.dk