SYNOPSIS AND FORECAST

The workshop was organized into two keynote speeches and four panels. It opened with a keynote speech by John Hines, Center Chief Technologist, NASA Ames Research Center,followed by two panels on Business and Applications in the morning of the June 20th. The afternoon program started with the second keynote by William J. Heetderks, Director of NIH/NIBIB Extramural Science Programs and two panels on Standards and Technologies. The video recording and PowerPoint files for all presentations as well as videoes of discussion among the attendees of the workshop are available at http://www.cwins.wpi.edu/workshop11/program.html . Workshop discussions brought out a number of observations on BAN research to date as well as future technical directions for this rapidly-growing field. To prepare a synopsis and forecast of important technologies that require research and development , we reviewed the PowerPoint presentations and video recordings of the discussions at the workshop and additional comments submitted by panelists. Here we paraphrase and summarize, in categories, major points and recommendations offered by the workshop participants.

General Comments:

There was a general agreement that BAN technology, particularly with respect to health care, is a very important and rapidly growing field for new research and development at many levels. More specific overall comments about the field and the workshop included:

• Presentations on standards (IEEE 802.15.6 and IEEE 802.15.4j) showed that important progress is being made on the standardization front.  As the workshop was in session, letter balloting on the IEEE 802.15.6 draft was in progress. 
• A number of standards exist today, bringing their representatives in the workshop would help moving applications further forward.   In addition, while agreement on standards is vital for the industry to be able to move ahead with product and system developments, the standards should allow enough flexibility (e. g., with respect to frequency bands of operation) to allow for entry of new networking concepts.


• Regarding the future directions in standardization, it would be desirable to develop a summary of ideal capabilities that medical community is looking for.

• Regarding the focus of innovative research, for Cardio related conditions, there has been a significant amount of sensor innovation aimed at gaining a better  understand the human heart.   The next frontier is Neuro to better understand the brain.   We believe that body area networks that can un-lock mysteries of the brain would be rewarded by the markets.


• Regarding the general approach to support innovative research and development, since this is a widely diversified multi-disciplinary area of research perhapseach of the participants was biased towards their own areas of research andexpertise. So the best outcome can be expected by facilitating thenetworking and interactions between those whose areas are complementaryand can naturally mix and match to lead to greater ideas, winningproposals, and advanced collaborative research.  It is ideal to form a multi-disciplinary center of excellence for research in BAN to bring together talents from different disciplines related to BAN.

Fundamental challenges in this field exist in patient monitoring and healthcare delivery, security, localization, battery life, devices and propagation and modeling.

Patient Monitoring and Healthcare Delivery:

Many of the workshop presentations and ensuing discussions dealt with various aspects of health monitoring and healthcare delivery.  Topics ranged from health monitoring networks for out-of-hospital patients, to monitoring of emergency responders, to remote monitoring of astronauts in space, to advances in device technology, to applications in endoscopy and orthodontics, to fundamental propagation studies of wireless transmission in and around the human body. Specific topics are summarized below:

• The point was made by several participants that “we are not trying to replace the doctor,” but we want to use technology to provide the medical professionals as much information as possible about the patient’s condition so that the medical professionals can make a rapid and accurate assessment of the situation.  One view was expressed that this can be aided by compiling large amounts of data on biometric measurements and correlating the data with diagnostic information.

• A few of the presentations focused on systems for monitoring vital signs of first responders in emergencies, such as fires.  Research to date in the development of first-responder monitoring systems shows that monitoring of respiration rate is of critical importance.  The suggestion was also made that much valuable information can be obtained from “sleep studies.”

• Technology's role in healthcare is only compelling if it can mitigate the burden on an already taxed healthcare infrastructure, which is most notably limited by the capacity of clinicians. Technology needs to provide actionable decision support to solve the large scale problems we face today in healthcare. For this, we need algorithms that can analyze biomarkers to aid in diagnosis and disease management. The ability to integrate these algorithms in small-scale devices for the BAN would be a tremendous step.


• Adhesive and fabrics are a key issue for wearability.  We have not yet seen band-aid type of fabric sensors that are gentle on the skin, can be easily applied to the skin,  peeled off and re-applied.   Need to reach a range of at least 30 days non-stop wearable sensors.   3M and some other companies are working on this.  Perhaps even NASA would have solved some of these problems. Wearabilityis a serious issue for various conditions like sweat, hairy body, etc.

Security:

These new technologies will enhance the value of hospitals and clinics in delivering responsive healthcare, but it is important that these new technical systems operate securely. 

• The value added by hospitals and clinics is not only that these are places that provide responsive healthcare, but also that the care is (in principle) secure. Moving healthcare outside the hospital setting is a great thought for enhancing scalability, but security now becomes a much more challenging problem, since medical information is distributed and perhaps relying on generic network infrastructure for communication.


• With respect to security for medical information in the various systems and networks under consideration, the suggestion was made that using multiple levels of security can be valuable here.

• The implementation of effective encryption algorithms in turn affects power consumption in battery-powered devices.  This topic needs to be addressed in research for security in BAN.

Localization:

Localization inside the human body poses several fundamental questions seeking basic research.  

• Camera capsules have been of enormous benefit in the area of gastro-intestinal diagnosis, but a fundamental problem is still not solved: determining the precise location of the capsule when it spots a lesion at some intermediate location in the small intestine.  Estimation of location based on elapsed time is not accurate enough, since the capsule does not progress at a uniform rate of speed as it progresses through the intestinal tract.  Research in three-dimensional positioningalong with linear positioningin the tract are necessary.


• The body presents a non-homogeneous propagation environment that causes inaccuracies in measuring the distance based on time-of flight.  The reference points for localization are sensors installed over the body and they are subject to body movements.


• There was agreement among participants that the human body is a complex medium for RF propagation.  Electrical transmission parameters, conductivity and permittivity, vary significantly among different internal organs, and parameters can vary significantly across very short distances.  This presents a significant problem for the application of localization algorithms to diagnosis.

• Localization with millimeter accuracy is needed for orthodontistry applications.

Battery life:

Research in battery technology continues to make significant progress which would be beneficial for powering implanted and wearable devices.

• Battery life with current coin cell batteries is still too short.   Across all industries,  battery innovation has significantly lagged needs of industries like cell phones, consumer electronics,  etc.


• Wireless communication has an important role in autonomous implants, some planted within the human heart or major arteries.  Improving battery technology, including the recharging issue, is also very important for future research.


• Wireless powering of very small implants can eliminate the need for a battery, but presents the challenge of miniaturizing the receiving antenna within the implant.

Devices:

The workshop included discussion on devices used as implant or body mounted sensors.

• Research is ongoing in the area of wireless implants at various levels of miniaturization.  Making implants progressively smaller is an important area of research.


• Associated with advanced device technology, research in imaging techniques will also be valuable.

• One research goal is “chip in a cell,” and this is driving research in micro-miniature chemical sensors and pressure sensors.

Propagation Modeling:

Innovation in wireless networking heavily relies on application and propagation.   Support of new applications in and around human body demands analysis of radio propagation in and around human body and this medium has its own characteristics and challenges for propagation.

• An important aspect of the work done in preparing a standard was the recognition of the complexity of the human body as a medium of RF propagation.  Recognizing this, the 802.15.6 working group put considerable effort into developing a model for body-area RF propagation.

• The internal-body propagation problem can be summarized as propagation in a non-homogeneous medium.  It was commented that the problem of RF propagation in non-homogeneous media has been addressed extensively in the past in different contexts, e. g., under-sea RF communications and propagation through the earth’s crust for oil and mineral exploration.  Perhaps propagation models developed for earlier applications should be reviewed as part of efforts to develop more detailed models for BAN research.

• More research on absorption and transmission to far field for applications from the body to other parts of a house using 2.4 GHz is practically useful.

Future workshops:

There was a consensus that attendees learned something valuable from every single one of the presentationsand felt that it was a day very well spent.  Theysuggested a follow-up conference would be useful, either next year or in 2 years time, because this area is expanding rapidly.  Theyalso commented that the choice of topics was good in this workshop and should be maintained for the next one.

• It was suggested that more time should have been allocated to the discussions  among the workshop participants. To solve this problem, one attendee suggested that organizers can ask the presenters to submit some of their publications in advance to be included in the registration package, enabling presenters to shorten  their talk.  Another suggestion in this regard was to extend the workshop to start one hour earlier.


• It was suggested that we consider to restructure the workshop format to include break-out groups to address sub-topics.


• It was suggested that we invite rule-making organizations such as FCC and FDA Center for Devices and Radiological Health(CDRH) to participation in the future workshops.   Also, it was suggestedto  includeDoD participation given that they have made considerable investments on developing health monitoring applications for the soldiers.


• Depending on how you see it organized in the future, tutorials may be an interesting addition to the workshop, covering background and novel topics in some of the key subjects such as communications, platforms, data analysis, etc.


• Another suggestion for next time was to try to include other BAN applications such as aerospace, car, gaming, military and visualization.