Before the 20th century, medical care was delivered at home, through visits from mobile family physicians who packed the necessary medical technology into a doctor's bag. In the 20th century rare and expensive resources, such as heavy technology and specialist providers, had to be centralized in hospitals to make their utilization effective. Nowadays, the lack of hospitals in rural and underserved areas, the exponential complexity of lifestyle and the increasing of chronic diseases make healthcare a serious issue. Driven by quality and cost metrics, the healthcare systems have to change radically in the near future from current healthcare professional-centric systems to distributed networked and mobile healthcare systems. In this movement, the leading part is attributed to the pervasive technologies. More exactly, this approach is going to ensure prevention and not replace traditional medicine. Pervasive healthcare in contrast tries to change the healthcare delivery model: from doctor-centric to patient-centric, from acute reactive to continuous preventive, from sampling to monitoring.
In fact, rural residents have higher poverty rates, a larger percentage of elderly, tend to be in poorer health, have fewer doctors, hospitals, and other health resources, and face more difficulty getting to health services. Hence, one challenge of a pervasive healthcare system is how to provide better healthcare services to people using limited financial and human resources. Many medical errors occur due to a lack of correct and complete information at the location and time it is needed, resulting in wrong diagnosis and drug interaction problems. The required medical information can be made available at any place any time using sophisticated devices and widely deployed wireless networks.
The design and construction of a pervasive system for healthcare in rural areas appears very effective. It comes as a solution to help a patient adjust his lifestyle to his health requirements. Other than that, through patients' behavioral recognition we can detect diseases’ symptoms and predict their progression over time.
2. The architecture of a pervasive system applied in a healthcare context:
In this section we shall present an abstract architecture of pervasive healthcare systems, the impact of wireless networking solutions and how the health monitoring is based on context.
We can see that these systems follow the same high-level architecture and consist of:
Input-Output Subsystem: all these systems use sensory input, albeit of varying data types. This input is provided by sensors either attached to the user or to his entourage, by wearable devices or by specific healthcare devices that retrieve specific measurements.
Local Subsystem: the local subsystem locally collects sensory and other information and provides it to the healthcare system. The local subsystem may appear in the form of a single computer or as a small computing device like a PDA. In other cases, it may not be a concrete system but rather a collection of software agents each one specializing in a different operation. Lastly, some systems provide a middleware as a common operating platform so that the devices have a common understanding with the rest of the sensory system.
Remote Subsystem: all pervasive healthcare systems send the data collected to a specific service provider that either does some kind of processing on it, or stores it into health medical records. Usually these subsystems reside on Healthcare service providers, capable of providing scientific monitoring of the data and checking whether the patient is in a critical condition or not in order to provide immediate support.
We define pervasive healthcare as :
« healthcare to anyone, anytime, and anywhere by removing location, time and other restraints while increasing both the coverage and the quality of healthcare ».
The pervasive healthcare applications include pervasive health monitoring, intelligent emergency management system, pervasive healthcare data access and ubiquitous mobile telemedicine. The wireless networking solutions include the use of wireless LANs, ad hoc wireless networks, cellular/GSM/3G infrastructure-oriented networks and satellite-based systems (Figure 1).
Context is any information that can be used to characterize the situation of an entity which is a person, place or object. It can consist of both implicit and explicit information and can even be further divided among low-level (such as time, temperature and bandwidth) and high-level contexts (complex user activity). In wireless health monitoring, healthcare professionals will make decisions based on knowledge derived from multiple set of informational items such as patient’s medical history, current vital signs, medical knowledge and specific patient conditions. Figure 2 shows how medical information can be represented for individual patients to achieve a high degree of personalization. The vital signs are defined with multiple thresholds, set of actions, undesirable patterns, and interrelationship between multiple vital signs. The representation of medical information will be helpful for a behavioral recognition of patients by utilizing both stored and live information.
3. Operational and decisional system:
This section describes how to use the Two Track Unified Process Model to develop the technical part of the pervasive mobile healthcare system regardless of context conception. A business model will be presented with the contribution of the Cloud Computing in this system.
3.1 Two Track Unified Process (2TUP) Model:
For the sake of software quality, flexibility and reusability, the Two Track Unified Process (2TUP) Model is seen as appropriate for the development of our system. 2TUP is an open industry standard. It is component oriented, offering flexibility to the model and supporting the reuse. It allows a better technical risk management : deadlines, costs control... Indeed, the technical importance of the application to develop makes its reuse in other contexts possible. Of course, an information system as it exists in the Pervasive Mobile Healthcare System can be used fully in other sectors.
The 2TUP Model (Figure 3) notes that any development on the system can be decomposed and treated in parallel according to a functional axis and a technical axis. We can thus study independently the evolutions bound to the changes both in terms of functional needs and technical needs. At the conclusion of these stages of analysis, the conception merges needs to realize the system. The left (functional) branch contains: the capture of business requirements and their analyses. The results of the analysis do not depend on any particular technology. The right branch (technical architecture) contains: the capture of the technical needs and the generic design. The technical architecture builds the skeleton of the computer system and spreads most of the risks of technical level. The importance of its success is such that it is advised to make a prototype to assess its validity. The two branches are then merged into a medium branch, which supports preliminary design, detailed design, coding, tests and validation steps.
The right branch capitalizes on technical know-how. It constitutes an investment for the short and medium terms. Techniques developed for the system can indeed be independent of the functions to be realized. The technical architecture is moreover less and less the preoccupation of the computing services. In fact, the existence of application servers and the standardization of the Web Services reflect this trend with « ready to integrate » technical architectures. Technical architecture is indeed immediately reusable for various business cores in various systems (Figure 4).
3.2 Business Model:
Figure 5 presents the actors, tools, activities and artifacts within the system. The cycle begins when a physician from a medical caravan consults a patient for the collection of information. Following this consultation, the doctor inputs this information in the database of a healthcare center through a mobile device. More information is needed for patient monitoring such as the climatic conditions prevailing in that area, the spreading rate of such a disease in similar circumstances, the epidemic history of that particular area. These information can be gleaned from various sources like the Web or other data repositories. For this, we use the ETL tool (Extract Transform and Load) to ensure data integration in the system. After the construction of an aggregated Data warehouse, the patient's history is established. Then, the physician analyzes the potential information of the patient, understand the behavior and classify symptoms to extract useful knowledge. Knowledge is used to represent Patient’s Pattern that help predict the state of disease progression in a patient, make the reports and predict the statistics of coming months. Based on these results, the doctor decides the best treatment for the patient.
3.3 Pervasive Mobile Healthcare System Based on Cloud Computing:
We all know the importance of information evolves according to its fast and its proper use. The information system of the pervasive mobile healthcare system maintains a critical type of information. Indeed, this is information related to our life. So we must be agile as much as possible in the analysis of this information, the understanding of results and the delivery of solutions and suggestions.
With Cloud Computing, we go beyond the simple recording of data in order to perform treatments on Cloud Databases or Cloud Data marts. Also through the process of Cloud Data Mining we can do analysis of information taken from the patient in a short time: attack the Cloud of the healthcare center through a simple spreadsheet in the mobile device and pilot analysis from this interface. Therefore, we can have instant results, a quick update of Patient’s Pattern, reports issued immediately, correct decisions and a more efficient rescue. Hence, the patient will have a cure sooner and also protection against epidemics. Another advantage of the Cloud is seen through the minimization of communication flows between the actors in the system: they all converge on the cloud to store and extract information or to treat it.
From another perspective, Cloud Computing offers to the healthcare center one auxiliary environment for disaster recovery, an advanced level of data security and efficiency of services. Here, Cloud Computing allows you to practice different techniques of processing information without having strong involvement in the architecture of the organization therefore benefitting from the tools of business intelligence without spending much. Hence, the infrastructure of the healthcare center will be smaller and more stable.
In conclusion, with an increasingly mobile society and the worldwide deployment of mobile and wireless networks, the wireless communication can support many emerging healthcare applications. Much progress is being made to develop pervasive mobile healthcare systems to fill in the lack of hospital and medical care in rural or underdeveloped areas.
The purpose is to provide people with a fast access to specific medical care and diagnosis to fulfil the vision of "Pervasive Healthcare" or healthcare to anyone, anytime, and anywhere. Hence, Cloud computing is an efficient means to manage data sharing and discussions between patients, local subsystems, databases and physicians while increasing information speed.
 P. Roques & F. Vallée, (2007). UML 2 en action: De l’analyse des besoins à la conception, https://www.eyrolles.com/Informatique/Livre/uml-2-en-action-9782212121049/  U. Varshney, (2007). Pervasive Healthcare and Wireless Health Monitoring, https://link.springer.com/article/10.1007/s11036-007-0017-1  A. Kameas & L. Calemis, Pervasive Systems in Health Care, https://cs.gmu.edu/~jpsousa/classes/895/readings/0315.pdf
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Find out more:
1) Chapter 10 : Communication Issues in Pervasive Healthcare Systems and Applications, D. Vouyioukas, I. Maglogianni, book chapter, https://www.researchgate.net/publication/344213370_Communication_Issues_in_Pervasive_Healthcare_Systems_and_Applications
2) Publication de l'Etude européenne FIEEC / ASIP Santé sur la télémédecine et la télésanté, https://esante.gouv.fr/sites/default/files/media_entity/documents/Enseignements%20FIEEC-ASIPSante_tirese_de_le_etude_europeenne_telesante.pdf
4)La télémédecine mieux encadrée, https://www.cnil.fr/fr/cnil-direct/question/telemedecine-quelles-formalites-la-cnil