Wireless Pers Commun

DOI 10.1007/s11277-015-2999-5

Smartphone Applications for Providing Ubiquitous

Healthcare Over Cloud with the Advent of Embeddable
Implants
Nikhil Ravikumar1 Neil H. Metcalfe1
Jeevarathinam Ravikumar2 Ramjee Prasad3

 Springer Science+Business Media New York 2015

Abstract The world we live in today has been defined by the rise of the smartphone and
smartphone apps. There is a huge potential for these apps to have an impact in healthcare
via the use of the emerging field of biosensor technology in the form of wearables and
implants. This paper discusses the future of healthcare from a technological standpoint,
looking specifically at the use of these wearables and implants in conjunction with the
power of cloud computing to provision healthcare in efficient and effective ways. There is
also a discussion involving a specific example of how an app currently in development can
be augmented with biosensor technology in the near future.
Keywords Telemedicine
mHealth
Embeddable
Implants
Wearables
COPD

Biosensors
Smartphone
Apps

& Jeevarathinam Ravikumar

jrravikumar@gmail.com; jravikumar@ieee.org
Nikhil Ravikumar
hynr3@hyms.ac.uk
Neil H. Metcalfe
neilmetcalfe@doctors.org.uk
Ramjee Prasad
Prasad@es.au.dk
1

HYMS Medical School, York, UK

Technopreneur, Singapore, Singapore

Center for TeleInFrastruktur (CTIF), Aalborg University, Aalborg, Denmark

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1 Introduction
The twenty-first century world we live in has been defined by technological advancement
at a rapid pace enabling an ever-growing interconnectedness between people in all corners
of the world. Cellular communication and the internet have made it possible for us to
constantly be in touch with those closest to us.
Smartphones represent a new generation of communication devices which have rapidly
gained traction worldwide. They are changing the way we use the internet and the way we
share information with others. Instead of browsing web pages on a computer, we
increasingly use mobile applications. These applications enable us to share limitless
varieties of content with others such as pictures, videos, maps, documents and more with
just these pocket sized devices. An activity such as jogging can be tracked through our
phone, which can give us useful real time information such as our pace and distance. It is
also capable of recording long-term information such as how much our running times have
improved over a period of time.
This evolution from desktop to mobile is starting to affect the field of healthcare and
medicine. Telemedicine is the umbrella term used to define the use of technology in
medicine. This is also following a similar path, integrating mobile computing, mobile
sensors, and communications technology to enhance and optimise the delivery and provisioning of healthcare. This branch of telemedicine is termed mobile-health, or mHealth
[13]. Advances in this field will be closely tied to concurrent innovation and research in
smartphones, wearables, implants as well as wireless communication technologies and
protocols.
The work presented in this paper is also of immense significance and its full utility can
be derived utilizing future mobile communication standards, i.e., fifth generation (5G). 5G
is expected to be driven relying on the wireless innovative system for dynamic operating
mega-communications (WISDOM) concept [4].

2 Body Sensor Networks: Present Status

Wearable technology is already in use in mainstream healthcare. Devices such as pulse
oximeters and 24 h ECG monitors are placed on patients to continuously record information on the patients condition. While these have been deemed feasible for the purposes
of existing healthcare infrastructures, these devices are primitive in design and technology.
They are not designed with mass, personal use in mind, but are for healthcare professionals
who understand the data and use it to make medical decisions. Upcoming smart wearables
from major consumer electronics companies will utilise existing biosensor technology such
as those in hospital approved monitors packaged into sleek devices. These devices will
have the ability to analyse the incoming data and use it to inform the user about their
health. Examples of such devices will be watches, wristbands, necklaces, and rings. These
non-invasive devices are the first step towards personal biosensor integration and will
enable individual data collection on a large scale. Further down the line for personal
biosensor integration are implantable chips. Unlike wearables, these are not limited to
noninvasive monitoring and thus will provide a wider range of measurements such as blood
markers [5].
An individual in the future will likely have multiple implants as well as multiple smart
wearables, forming an individual personal monitoring and information-gathering ecosystem.

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The framework that connects this ecosystem is termed a body area network (BAN) or a body
sensor network (BSN) [6] and will rely on wireless communication between these sensors to
send and receive data.
The biosensors act as nodes within these BANs/BSNs, which will themselves form
nodes as part of the users wireless personal area network (WPAN). This personal network,
hosted by the users smartphone, will act as the conduit between these biosensors and the
world around the user, and of course, the internet [68].
Figure 1 illustrates the body area network that may form the basis for mHealth in the
future. It will use smartphones or other devices in the users Personal Area Network to
connect to the internet.

3 Applications
Data from these sensors and wearables will be useful only if there is a system to analyse
and make sense of it. The users smartphone, although immensely powerful for a small
device, is unlikely to be very efficient at interpreting this data. This is where cloud
computing can be very useful for performing detailed analysis on the incoming data, which
could then inform future treatment decisions and assist in emergencies.
BSN nodes in the patient can sense changes in the patients physiology and relay this
information to the cloud. An analytics platform over the cloud can process this data and
proactively detect that the patient is about to undergo an adverse event. The system can
then initiate the appropriate management pathway for the patient. Information on how to
handle the situation can be relayed to the patient via a smartphone app before paramedics
and doctors from the nearest hospital arrive. The paramedics and relevant healthcare
personnel can be informed in advance about the exact context and complications of the

Fig. 1 Body area networks

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patients situation with data from the cloud analytics server. Hence enabling them to
proactively tailor the emergency equipment and treatment to the patients needs.
Constant long term monitoring will make healthcare provisioning highly personalised.
Doctors and healthcare professionals will have access to extensively detailed patient
records. These records can be used to more precisely to predict patient outcomes and
formulate treatment plans that are meticulously calibrated to deliver the most effective
treatment to the individual. It might be possible to calculate optimum routes and pathways
suited to the individual for drug action and use this information to determine the best drug
formulation and dosage for each patient. As these plans are carried out, real-time data
streams from the patient can be used to algorithmically modify and adjust the treatment. In
a sense, medical treatment will become very dynamic and sensitive to changes in the
patients physiological state.
There already exist implants capable of delivering treatment autonomically to the
patient. One such example is insulin pumps for diabetic patients. These devices continuously infuse insulin into patients throughout the day. Their dosages have to be manually
modified by the patient based on upcoming meals or activities [9]. If these patients can be
implanted with biosensors capable of leveraging cloud analytics to calculate dosages
through predictive algorithms, then they can be freed of having to meticulously manage
conditions themselves and subsequently enjoy a better quality of life.
Cloud driven collective analysis of data from millions of patients can also benefit the
drug development process itself. It would be possible to obtain information on the efficacy
of a drug and the prevalence of its side effects to use this knowledge for better drug design
and delivery.
These mHealth technologies will allow for exceptionally early screening and identification of diseases and conditions. Advance detection of affected patients is likely to
improve prognosis and survival in the case of life threatening conditions such as cancer,
which is known to regularly develop without symptoms [10]. In pandemic situations, data
from these sensors could be used to precisely monitor disease spread and create effective
strategies to control and prevent further infection.

4 Potential for Evolution of Current Technology

Current health and medicine related applications on smartphones are severely limited in
terms of their functionality. However, there is a great potential to augment the usability and
feature set of these applications via the use of biosensors and biosensor networks.
A patient drug tracker app on a patients smartphone today, currently in development by
the authors, may be only able to keep a list of the patients medications and notify patients
when they need to take their medicine. In the future, however, biosensors in the form of
wearable devices or implants may be able to provide data to health apps. These apps would
then be able to analyse the data to provide important information to the patient regarding
their health.
Spirometry is a test used to evaluate a patients lung function and tends to be very useful
in patients with lung disease such as asthma and chronic obstructive pulmonary disease
(COPD). Currently, spirometry is only done in healthcare settings rather than by the
patients themselves because of the availability of the equipment and the need for a trained
professional to operate it.

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Recent research has shown that it may be possible for spirometry to be done noninvasively via measurement of sounds made by the user during breathing. This is termed
phonospirometry [11]. With this research in mind, it is possible to imagine a wearable
device, likely in the form of a pendant that can continuously measure a patients airway
function through this method. A smartphone app would be able to access the data recorded
by this wearable device and subsequently present the data and analysis to the user in a
simple format, as depicted in Fig. 2. Spirometry data is usually graphically presented in the
form of flow-loops, which could be used within this app as a way of presenting data to the
user, as seen in Fig. 3. Ultimately, the data from the sensor should be used to analyse the
patients lung function and look for any changes or trends that might indicate deterioration
in function. These findings could then be further analysed, based on the patients known
medical history to predict if the patient is about to experience an asthma attack or an
exacerbation of their COPD.
For example, if the app detects that an asthma patients airways are deteriorating in a
pattern typical of an attack, then the app could give the patient an early warning. Thus
prompting them to use their inhaler device in advance to prevent the attack from progressing further than the early stage it was detected in. In the long term, data from the
wearable could be analysed by the app to determine how well controlled the patients
asthma is in terms of number of episodes. Patients physician could use this information to
meter their inhaler medication. This data analysis could be based on known trends as
measured by previous research or could even be based on information and data from other
users of the wearable.
This wearable and app could also be used in patients deemed to be at risk of developing
chronic lung disease such as COPD to screen them based on long term lung function and
identify patients in need of treatment earlier resulting in improved prognosis. Data from
many users could even be analysed in the cloud to identify patients developing lung

Fig. 2 Drug information and tracking application on the iPhone Operating System (iOS) platform currently
in development by the authors

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Fig. 3 An evolution of future app similar to the drug tracker (Fig. 2) augmented by biosensors allowing
monitoring of vital information such as lung function and predict adverse events

conditions in geographical clusters exposed to environmental factors such as unidentified

harmful substances.

5 Conclusions
mHealth has the potential to critically define and expand the role of medicine and medical
services in the decades to come. Wearables and implants operating as nodes in body area
networks with the ability to leverage cloud computing for data analysis can form the basis
for greatly augmented and optimised healthcare services. Users of these wearables and
sensors may be able to benefit from improved prognosis as a result of continuous health
tracking and fast data analysis. Although it will take many years of research before most of
the applications outlined here become practical and commercially viable, it is important to
recognise these as future goals to motivate continued innovation and progress in the
telemedicine field.

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Nikhil Ravikumar is a medical student at the Hull York Medical
School, University of York, UK. He has published iOS apps in the app
store and is interested in the convergence of technology and medicine
to improve prevention, monitoring and treatment.

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Neil H. Metcalfe is a GP in York with a specialist interest in medical
education. He has a wide experience of teaching at different medical
schools as well as being a medical writer with over 50 publications to
date.

Jeevarathinam Ravikumar is a Technopreneur with over two decades of experience in technology research and commercialization. His
research interests include next generation technologies that can enrich
human life. He is a Senior member of IEEE.

Professor Ramjee Prasad is Director at CTIF, Aalborg, Denmark. He

is one of the most renowned professors in wireless telecommunications
research and is currently leading 5G standards worldwide.

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