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5G as enabler for Digital Healthcare

5G as enabler for Digital Healthcare DE GRUYTER Current Directions in Biomedical Engineering 2020;6(3): 20203001 Steffen Hamm*, Ann-Christin Schleser, Juliana Hartig, Petra Thomas, Silke Zoesch and Clemens Bulitta Abstract: Healthcare in rural areas faces specific (digitisation) and encrusted care structures reinforce this and challenges, which make homecare of elderly people and lead to a leverage effect. Particularly in rural areas – which cross-sectoral integrated care of chronically ill and include the Northern Upper Palatinate – the provision of multimorbid patients very complex and costly. Mobility and medical care close to the individuals’ homes is becoming logistics are among other issues that need to be solved in this increasingly difficult. Spatial distances are not only a context. Therefore, it will be crucial to realize the potential of challenge in acute care, but also make homecare for the innovative solutions along the complete healthcare value elderly and the integrated, cross-sectoral care of multimorbid chain, in order to deliver patient focused healthcare according and chronically ill patients very resource-intensive. Questions to a value-based-healthcare-approach in the future. Against of mobility and logistics are becoming central challenges for this background it is the objective of the project healthcare. Therefore, it will be crucial to realize the 5G4Healthcare, which is funded by the Federal Ministry of potentials of innovative solutions along the entire healthcare Transport and Infrastructure, to establish a platform based on value chain in order to deliver patient-oriented healthcare 5G technology, that enables the testing and the evaluation of according to a value-based-healthcare approach. In contrast digital applications in the context of rural healthcare. to sector related care (outpatient-inpatient), in which the Consequently, the project 5G4Healthcare aims at assessing added value is understood as the sum of individual services, the feasibility, opportunities and limitations of 5G regarding the value-based-healthcare approach aims at seamless and efficiency and effectiveness improvements in rural healthcare thus integrated care that is measured against the actual, in order to derive recommendations and scalable solutions. individual needs of the patient and the personal benefit achieved for his or her individual state of health. However, this paradigm not only enables these individual benefits, but Keywords: rural healthcare, digital healthcare, 5G, also an improvement of efficiency and effectiveness in integrated care, homecare medical care from an economic perspective. In the Northern Upper Palatinate it is already clear that healthcare as we https://doi.org/10.1515/cdbme-2020-3001 know it will change. In the outpatient sector, for example, the current General Practitioner (GP) care can still be considered sufficient, but the age structure of practicing GPs and the fundamental regional population development make 1 Status quo healthcare in comprehensive care increasingly difficult in the future. In rural areas some communities, more than 40 percent of GPs are already over 60 years old [1]. It is uncertain whether each of the GPs Healthcare industry is both a growth market and an industry will find a successor. The inpatient sector also shows that that under enormous economic pressure. This conflict becomes the care structures are undergoing a process of change. In the obvious in demographic change, increasing morbidity, a hospital group of the Kliniken Nordoberpfalz AG, which shortage of skilled workers, medical-technical progress and a includes – besides the hospital in the city of Weiden that growing sense of entitlement to healthcare among the provides full medical care and acts as referral centre – also population. Insufficient health and technology competence smaller locations, facilities have already been repurposed in recent years – e. g. to specialized clinics – and acute inpatient care has been discontinued. This illustrates that the region is ______ facing typical challenges of rural healthcare, and that * Corresponding author: Steffen Hamm, Technical University of innovative concepts and care models are necessary in order to Applied Science Amberg-Weiden, Hetzenrichter Weg 15, Weiden, preserve comprehensive healthcare coverage. Digital Germany, e-mail: s.hamm@oth-aw.de Ann-Christin Schleser, Juliana Hartig, Petra Thomas, Silke solutions may be critical for managing this transition and Zoesch and Clemens Bulitta, Technical University of Applied maintaining efficient and effective healthcare delivery Science Amberg-Weiden, Hetzenrichter Weg 15, Weiden, despite these major changes. Germany Open Access. © 2020 Steffen Hamm et al., published by De Gruyter. This work is licensed under the Creative Commons Attribution 4.0 License. Steffen Hamm et al., 5G as enabler for Digital Healthcare — 2 enable location-independent availability of patient data of 2 The project 5G4Healthcare patients participating in integrated care (keyword electronic health record). Additionally, concrete measures of Against this background it is the objective of the project telemedical therapy and diagnostics (keyword tele- 5G4Healthcare, which is funded by the Federal Ministry of consultation) facilitate the cooperation of professions Transport and Infrastructure until the end of 2022, to involved, which is also independent of location. In the final establish a platform based on 5G technology, that enables stage, the aim is to create a virtual care centre which, in testing and evaluation of digital applications in the context of addition to conventional care facilities, will enable rural healthcare. Along the entire healthcare value chain, permanently available high-quality treatment by experts, from prevention to diagnostics, therapy, rehabilitation and even if the actual coverage of care further decreases. care, defined use cases and a standardised procedure are to be Also, the second use case aims towards implementation used to determine which value-added effects can be realised of a comprehensive digital health-based approach, explicitly through digital solutions in rural healthcare and, in particular, addressing homecare in rural areas. Here challenges in which impact the 5G technology can provide in this context. securing seamless care especially arise from the extremely In a three-step approach consisting of conception, decentralized infrastructure. GPs, nursing services and implementation and evaluation, a 5G-based research and patients´ relatives travel considerable distances between their development platform will be implemented as a network with location, the patient and other actors such as pharmacies or corresponding living labs and test beds. In this context two medical supply stores. It is not uncommon for medication to major use cases comprehensively address the challenges of be out of stock; they are ordered by pharmacy and delivered healthcare in rural areas and enable a multi-dimensional by medical supply store at a later date. Also, medical aids are evaluation of the use of 5G. On the one hand, this is intended often delivered by the medical supply store at a later date. to create a direct added value and starting point for future Moreover, especially in rural areas, it is not unlikely that the supply solutions and structures in the Northern Upper nursing service is not updated immediately about new Palatinate and, on the other hand, to make an important medication or changes of medication. This can lead to contribution to the federal government´s 5G strategy, into incorrect drug administration with dramatic consequences. which the funding by the Federal Ministry of Transport and Due to lack of communication between GP – patient – Infrastructure is to be classified. The intended testing of 5G pharmacy – medical supply store – nursing service – health applications in a real environment (living labs) will allow insurance company, current care of homecare patients in rural detailed requirements, ideas and solutions to be derived that areas is complex, costly and afflicted with many sources of will serve as a blueprint for a comprehensive 5G error. implementation in healthcare. On application level, therefore, solutions are to be used that primarily contribute to the optimization of the entire logistics around the homecare patient. In addition to 3 Focus use cases “integrated information and patient logistics (e.g. organisation of patient transport) the main focus – in terms of content and processes care” and “homecare” – is on fast and correct coordination of supply of drugs, sterile goods, medical supplies, etc. By connecting the actors Within the framework of the use case integrated care and in rural homecare around a patient, a relief for all parties with the involvement of representatives of the outpatient and involved is to be aimed in order to achieve a higher quality of inpatient sectors, a comprehensive digital-health-based care and economic optimisations for service providers. The integrated care approach for rural areas is to be implemented. secondary objective is to achieve care in a domestic According to the objective of integrated care, which is environment for a longer time. The infrastructure for the intended to overcome the sectoral boundaries in the German actors involved is to be supplemented by the use of assistance healthcare system, the patient is supposed to benefit from solutions and smart devices for a self-determined life in daily high-quality care by the close interconnection of care sectors. situations (ambient assisted living) as well as by automation For participating service providers, there are opportunities solutions. apart from the rigid collective agreement system with innovative care options and thus new and additional remuneration and an overall more efficient allocation of resources. In order to implement this, telemedical procedures are to be used technically at the application level, which Steffen Hamm et al., 5G as enabler for Digital Healthcare — 3 full potential in a 5G network. These digital health 4 5G: The catalyst to applications and solutions include, for example, robot- digitisation assisted operations, remote monitoring and analysis of patients´ vital functions and video-based physician´s 5G is to be introduced in Germany as a new mobile consultations. For example, in robot-assisted surgery, there communication standard by the end of 2020. The new must be no long delays (low-latency) between the control standard is regarded as a pioneer for the Internet of Things impulse from the physician and the reaction of the surgical (IoT) and thus billions of networked end devices. Particularly robot. Data from cameras and sensors must be transmitted in rural areas, such as the Northern Upper Palatinate, with the highest reliability. In the future this may even make expansion of this gigabit network is not an end in itself, but is it possible for specialists located hundreds of kilometres breaking the ground for economic and social development in away to perform or support operations. When remotely st the 21 century. In many industries 5G is prerequisite for monitoring medical parameters of patients, it is important new business models such as predictive maintenance or IoT that sensors not only operate stably, but are also as durable as platforms which allow machines to exchange data with each possible and consume as little energy as possible. After all, other along industrial processes in a fully automated manner. these can also be sensors in body implants such as Autonomous and networked driving, logistics processes and pacemakers, which are only replaced after a period of many management of energy networks are just a few more years. 5G chips with long battery life offer tailor-made applications in which 5G can become a key technology. In solutions, e.g. for long-term monitoring of chronically ill doing so, 5G will enable continuously increasing patients. Finally, mobile digital health applications benefit requirements of digital applications in terms of capacity, from ability of 5G to guarantee stable connections even at bandwidth, availability and latency, which are prioritised high relative speeds of movement. For example, paramedics differently depending on application. There are three main can transmit their patients´ vital signs and video data from a application groups in which 5G can be used [2]: digitalized ambulance via 5G to the hospital without delay and obtain advice from specialists there. A benefit of 5G, that Enhanced Mobile Broadband (eMBB): High bit rate can save lives, especially in rural areas where the transfer to a applications, such as ultra-high resolution video streaming, hospital or specialist clinic is long. In particular, the are characterized by high bandwidths per user and high advantage of rapid transferability of large data volumes at 5G capacities in one cell. is added in this telemedical context when it comes to Massive Machine Type Communication (mMTC): When transferability of medical image data, e.g. in form of video every object is interconnected, the Internet of Things is data, MRI or CT images. High transmission rates, partly in becoming reality. Communication with control centres that is real-time, can be seen synonymous with faster and therefore made possible by this development places are demands on more effective treatment of the patient in an emergency. This network capacity in terms of managing hundreds of also applies to the location-independent use of applications thousands of locked-in devices per cell. with artificial intelligence or Augmented Reality (AR) and - Ultra-Reliable and Low-Latency Communication (URLLC): Virtual Reality (VR) applications, which can represent Safety-critical applications, e.g. in medical care, depend on further value-added scenarios of 5G development in (rural) maximum quality, availability and interference immunity healthcare. (quality of service) of connections. In addition, they also require tactile networks that transmit mission critical data in In order to test and evaluate possibilities and limits of 5G, the real time. project is organized in three phases as sequence of conception, implementation and evaluation. The aim is to Simplified the application scenarios can be summarized in design, test and evaluate the use of 5G from different terms of requirements in the cases of “many users”, “large perspectives – medical, technical, (health) economic, social, data volumes” and “low latency”. Individually or in etc. - in the two use cases integrated care and homecare. In combination, these use cases represent elementary scenarios, detail this is achieved for the use cases applying different especially in the healthcare sector, in order to explicitly scenarios which are defined, modelled, prioritised and guarantee the security of healthcare delivery for the selected with an appropriate set of methods and tools in the population in rural areas in the future. first step of the conception phase of the project. The scenarios will first be created in a test bed on the premises of A majority of digital health applications can only reach their the Technical University of Applied Sciences Amberg- Steffen Hamm et al., 5G as enabler for Digital Healthcare — 4 Weiden and further detailed in a situation analysis, on the There is a close connection between the identification of the basis of which an intended target concept will be modelled. scenarios to be worked on, the multidimensional processing In the second phase, the implementation, the scenarios will and evaluation as well as healthcare challenges that actually be tested in a real environment. For this purpose, so-called exist on site and are typical for rural areas. The main living labs are planned at local care facilities, sites of the objective of the project is to derive recommendations for cooperation partner Kliniken Nordoberpfalz AG. There the action regarding use of 5G and fundamental digitisation in scenarios will then be assessed from different perspectives. the healthcare system as well as to create the necessary These i.e. include medical outcome, health economic effects, framework and conditions. By establishing necessary the already mentioned technical trade-off between 4G and infrastructure, prerequisites for application-oriented research 5G, data protection aspects and regulatory affairs, logistics and a process of translation in the field of digital healthcare issues, IT security issues or ethical aspects. In the third phase, management will be sustainably created. It is therefore the evaluation, these real scenarios are assessed using a intended to continue the structures of test beds and living labs maturity model developed in-house. This model views the beyond the planned project duration and thus to provide a scenarios from a holistic perspective and structures the permanent platform for the testing and development of digital optimization cases according to the quality dimensions of applications in the healthcare sector within a 5G infra- structure, process and result. Each dimension is evaluated structure. On the one hand this will enable the nationwide and subdivided. The result will for example deal with the digitisation of healthcare, testing of innovative solutions and sub-dimensions costs, quality, patient and staff satisfaction the establishment of new care processes and models. On the based on the Quadruple Aim concept. other hand, a blueprint for future-oriented healthcare in rural areas will be created. The multi stage approach shows that the project 5G4Healthcare is not about the sole application of 5G Author Statement technology in the sense of replacement of 4G or WiFi, but Research funding: Funding provided by the Federal rather about the derivation of a scenario-related setting of Ministry of Transport and Infrastructure context factors in order to derive the maximum added value Conflict of interest: Authors state no conflict of interest. of 5G in healthcare use cases - with regard to the effectiveness and efficiency of the technology. References 5 Recommendations for [1] Spiekermann & Wegener Stadt- und Regionalforschung, Analyse der Versorgung mit Einrichtung und actions and long-term use of Dienstleistungsangeboten der sozialen Infrastruktur in der Planungsregion Oberpfalz-Nord; 2018 the platform [2] BMVI, 5G-Strategie für Deutschland; 2017 The processing of use cases with the corresponding scenarios is characterized by a high level of application relevance. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Current Directions in Biomedical Engineering de Gruyter

5G as enabler for Digital Healthcare

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Abstract

DE GRUYTER Current Directions in Biomedical Engineering 2020;6(3): 20203001 Steffen Hamm*, Ann-Christin Schleser, Juliana Hartig, Petra Thomas, Silke Zoesch and Clemens Bulitta Abstract: Healthcare in rural areas faces specific (digitisation) and encrusted care structures reinforce this and challenges, which make homecare of elderly people and lead to a leverage effect. Particularly in rural areas – which cross-sectoral integrated care of chronically ill and include the Northern Upper Palatinate – the provision of multimorbid patients very complex and costly. Mobility and medical care close to the individuals’ homes is becoming logistics are among other issues that need to be solved in this increasingly difficult. Spatial distances are not only a context. Therefore, it will be crucial to realize the potential of challenge in acute care, but also make homecare for the innovative solutions along the complete healthcare value elderly and the integrated, cross-sectoral care of multimorbid chain, in order to deliver patient focused healthcare according and chronically ill patients very resource-intensive. Questions to a value-based-healthcare-approach in the future. Against of mobility and logistics are becoming central challenges for this background it is the objective of the project healthcare. Therefore, it will be crucial to realize the 5G4Healthcare, which is funded by the Federal Ministry of potentials of innovative solutions along the entire healthcare Transport and Infrastructure, to establish a platform based on value chain in order to deliver patient-oriented healthcare 5G technology, that enables the testing and the evaluation of according to a value-based-healthcare approach. In contrast digital applications in the context of rural healthcare. to sector related care (outpatient-inpatient), in which the Consequently, the project 5G4Healthcare aims at assessing added value is understood as the sum of individual services, the feasibility, opportunities and limitations of 5G regarding the value-based-healthcare approach aims at seamless and efficiency and effectiveness improvements in rural healthcare thus integrated care that is measured against the actual, in order to derive recommendations and scalable solutions. individual needs of the patient and the personal benefit achieved for his or her individual state of health. However, this paradigm not only enables these individual benefits, but Keywords: rural healthcare, digital healthcare, 5G, also an improvement of efficiency and effectiveness in integrated care, homecare medical care from an economic perspective. In the Northern Upper Palatinate it is already clear that healthcare as we https://doi.org/10.1515/cdbme-2020-3001 know it will change. In the outpatient sector, for example, the current General Practitioner (GP) care can still be considered sufficient, but the age structure of practicing GPs and the fundamental regional population development make 1 Status quo healthcare in comprehensive care increasingly difficult in the future. In rural areas some communities, more than 40 percent of GPs are already over 60 years old [1]. It is uncertain whether each of the GPs Healthcare industry is both a growth market and an industry will find a successor. The inpatient sector also shows that that under enormous economic pressure. This conflict becomes the care structures are undergoing a process of change. In the obvious in demographic change, increasing morbidity, a hospital group of the Kliniken Nordoberpfalz AG, which shortage of skilled workers, medical-technical progress and a includes – besides the hospital in the city of Weiden that growing sense of entitlement to healthcare among the provides full medical care and acts as referral centre – also population. Insufficient health and technology competence smaller locations, facilities have already been repurposed in recent years – e. g. to specialized clinics – and acute inpatient care has been discontinued. This illustrates that the region is ______ facing typical challenges of rural healthcare, and that * Corresponding author: Steffen Hamm, Technical University of innovative concepts and care models are necessary in order to Applied Science Amberg-Weiden, Hetzenrichter Weg 15, Weiden, preserve comprehensive healthcare coverage. Digital Germany, e-mail: s.hamm@oth-aw.de Ann-Christin Schleser, Juliana Hartig, Petra Thomas, Silke solutions may be critical for managing this transition and Zoesch and Clemens Bulitta, Technical University of Applied maintaining efficient and effective healthcare delivery Science Amberg-Weiden, Hetzenrichter Weg 15, Weiden, despite these major changes. Germany Open Access. © 2020 Steffen Hamm et al., published by De Gruyter. This work is licensed under the Creative Commons Attribution 4.0 License. Steffen Hamm et al., 5G as enabler for Digital Healthcare — 2 enable location-independent availability of patient data of 2 The project 5G4Healthcare patients participating in integrated care (keyword electronic health record). Additionally, concrete measures of Against this background it is the objective of the project telemedical therapy and diagnostics (keyword tele- 5G4Healthcare, which is funded by the Federal Ministry of consultation) facilitate the cooperation of professions Transport and Infrastructure until the end of 2022, to involved, which is also independent of location. In the final establish a platform based on 5G technology, that enables stage, the aim is to create a virtual care centre which, in testing and evaluation of digital applications in the context of addition to conventional care facilities, will enable rural healthcare. Along the entire healthcare value chain, permanently available high-quality treatment by experts, from prevention to diagnostics, therapy, rehabilitation and even if the actual coverage of care further decreases. care, defined use cases and a standardised procedure are to be Also, the second use case aims towards implementation used to determine which value-added effects can be realised of a comprehensive digital health-based approach, explicitly through digital solutions in rural healthcare and, in particular, addressing homecare in rural areas. Here challenges in which impact the 5G technology can provide in this context. securing seamless care especially arise from the extremely In a three-step approach consisting of conception, decentralized infrastructure. GPs, nursing services and implementation and evaluation, a 5G-based research and patients´ relatives travel considerable distances between their development platform will be implemented as a network with location, the patient and other actors such as pharmacies or corresponding living labs and test beds. In this context two medical supply stores. It is not uncommon for medication to major use cases comprehensively address the challenges of be out of stock; they are ordered by pharmacy and delivered healthcare in rural areas and enable a multi-dimensional by medical supply store at a later date. Also, medical aids are evaluation of the use of 5G. On the one hand, this is intended often delivered by the medical supply store at a later date. to create a direct added value and starting point for future Moreover, especially in rural areas, it is not unlikely that the supply solutions and structures in the Northern Upper nursing service is not updated immediately about new Palatinate and, on the other hand, to make an important medication or changes of medication. This can lead to contribution to the federal government´s 5G strategy, into incorrect drug administration with dramatic consequences. which the funding by the Federal Ministry of Transport and Due to lack of communication between GP – patient – Infrastructure is to be classified. The intended testing of 5G pharmacy – medical supply store – nursing service – health applications in a real environment (living labs) will allow insurance company, current care of homecare patients in rural detailed requirements, ideas and solutions to be derived that areas is complex, costly and afflicted with many sources of will serve as a blueprint for a comprehensive 5G error. implementation in healthcare. On application level, therefore, solutions are to be used that primarily contribute to the optimization of the entire logistics around the homecare patient. In addition to 3 Focus use cases “integrated information and patient logistics (e.g. organisation of patient transport) the main focus – in terms of content and processes care” and “homecare” – is on fast and correct coordination of supply of drugs, sterile goods, medical supplies, etc. By connecting the actors Within the framework of the use case integrated care and in rural homecare around a patient, a relief for all parties with the involvement of representatives of the outpatient and involved is to be aimed in order to achieve a higher quality of inpatient sectors, a comprehensive digital-health-based care and economic optimisations for service providers. The integrated care approach for rural areas is to be implemented. secondary objective is to achieve care in a domestic According to the objective of integrated care, which is environment for a longer time. The infrastructure for the intended to overcome the sectoral boundaries in the German actors involved is to be supplemented by the use of assistance healthcare system, the patient is supposed to benefit from solutions and smart devices for a self-determined life in daily high-quality care by the close interconnection of care sectors. situations (ambient assisted living) as well as by automation For participating service providers, there are opportunities solutions. apart from the rigid collective agreement system with innovative care options and thus new and additional remuneration and an overall more efficient allocation of resources. In order to implement this, telemedical procedures are to be used technically at the application level, which Steffen Hamm et al., 5G as enabler for Digital Healthcare — 3 full potential in a 5G network. These digital health 4 5G: The catalyst to applications and solutions include, for example, robot- digitisation assisted operations, remote monitoring and analysis of patients´ vital functions and video-based physician´s 5G is to be introduced in Germany as a new mobile consultations. For example, in robot-assisted surgery, there communication standard by the end of 2020. The new must be no long delays (low-latency) between the control standard is regarded as a pioneer for the Internet of Things impulse from the physician and the reaction of the surgical (IoT) and thus billions of networked end devices. Particularly robot. Data from cameras and sensors must be transmitted in rural areas, such as the Northern Upper Palatinate, with the highest reliability. In the future this may even make expansion of this gigabit network is not an end in itself, but is it possible for specialists located hundreds of kilometres breaking the ground for economic and social development in away to perform or support operations. When remotely st the 21 century. In many industries 5G is prerequisite for monitoring medical parameters of patients, it is important new business models such as predictive maintenance or IoT that sensors not only operate stably, but are also as durable as platforms which allow machines to exchange data with each possible and consume as little energy as possible. After all, other along industrial processes in a fully automated manner. these can also be sensors in body implants such as Autonomous and networked driving, logistics processes and pacemakers, which are only replaced after a period of many management of energy networks are just a few more years. 5G chips with long battery life offer tailor-made applications in which 5G can become a key technology. In solutions, e.g. for long-term monitoring of chronically ill doing so, 5G will enable continuously increasing patients. Finally, mobile digital health applications benefit requirements of digital applications in terms of capacity, from ability of 5G to guarantee stable connections even at bandwidth, availability and latency, which are prioritised high relative speeds of movement. For example, paramedics differently depending on application. There are three main can transmit their patients´ vital signs and video data from a application groups in which 5G can be used [2]: digitalized ambulance via 5G to the hospital without delay and obtain advice from specialists there. A benefit of 5G, that Enhanced Mobile Broadband (eMBB): High bit rate can save lives, especially in rural areas where the transfer to a applications, such as ultra-high resolution video streaming, hospital or specialist clinic is long. In particular, the are characterized by high bandwidths per user and high advantage of rapid transferability of large data volumes at 5G capacities in one cell. is added in this telemedical context when it comes to Massive Machine Type Communication (mMTC): When transferability of medical image data, e.g. in form of video every object is interconnected, the Internet of Things is data, MRI or CT images. High transmission rates, partly in becoming reality. Communication with control centres that is real-time, can be seen synonymous with faster and therefore made possible by this development places are demands on more effective treatment of the patient in an emergency. This network capacity in terms of managing hundreds of also applies to the location-independent use of applications thousands of locked-in devices per cell. with artificial intelligence or Augmented Reality (AR) and - Ultra-Reliable and Low-Latency Communication (URLLC): Virtual Reality (VR) applications, which can represent Safety-critical applications, e.g. in medical care, depend on further value-added scenarios of 5G development in (rural) maximum quality, availability and interference immunity healthcare. (quality of service) of connections. In addition, they also require tactile networks that transmit mission critical data in In order to test and evaluate possibilities and limits of 5G, the real time. project is organized in three phases as sequence of conception, implementation and evaluation. The aim is to Simplified the application scenarios can be summarized in design, test and evaluate the use of 5G from different terms of requirements in the cases of “many users”, “large perspectives – medical, technical, (health) economic, social, data volumes” and “low latency”. Individually or in etc. - in the two use cases integrated care and homecare. In combination, these use cases represent elementary scenarios, detail this is achieved for the use cases applying different especially in the healthcare sector, in order to explicitly scenarios which are defined, modelled, prioritised and guarantee the security of healthcare delivery for the selected with an appropriate set of methods and tools in the population in rural areas in the future. first step of the conception phase of the project. The scenarios will first be created in a test bed on the premises of A majority of digital health applications can only reach their the Technical University of Applied Sciences Amberg- Steffen Hamm et al., 5G as enabler for Digital Healthcare — 4 Weiden and further detailed in a situation analysis, on the There is a close connection between the identification of the basis of which an intended target concept will be modelled. scenarios to be worked on, the multidimensional processing In the second phase, the implementation, the scenarios will and evaluation as well as healthcare challenges that actually be tested in a real environment. For this purpose, so-called exist on site and are typical for rural areas. The main living labs are planned at local care facilities, sites of the objective of the project is to derive recommendations for cooperation partner Kliniken Nordoberpfalz AG. There the action regarding use of 5G and fundamental digitisation in scenarios will then be assessed from different perspectives. the healthcare system as well as to create the necessary These i.e. include medical outcome, health economic effects, framework and conditions. By establishing necessary the already mentioned technical trade-off between 4G and infrastructure, prerequisites for application-oriented research 5G, data protection aspects and regulatory affairs, logistics and a process of translation in the field of digital healthcare issues, IT security issues or ethical aspects. In the third phase, management will be sustainably created. It is therefore the evaluation, these real scenarios are assessed using a intended to continue the structures of test beds and living labs maturity model developed in-house. This model views the beyond the planned project duration and thus to provide a scenarios from a holistic perspective and structures the permanent platform for the testing and development of digital optimization cases according to the quality dimensions of applications in the healthcare sector within a 5G infra- structure, process and result. Each dimension is evaluated structure. On the one hand this will enable the nationwide and subdivided. The result will for example deal with the digitisation of healthcare, testing of innovative solutions and sub-dimensions costs, quality, patient and staff satisfaction the establishment of new care processes and models. On the based on the Quadruple Aim concept. other hand, a blueprint for future-oriented healthcare in rural areas will be created. The multi stage approach shows that the project 5G4Healthcare is not about the sole application of 5G Author Statement technology in the sense of replacement of 4G or WiFi, but Research funding: Funding provided by the Federal rather about the derivation of a scenario-related setting of Ministry of Transport and Infrastructure context factors in order to derive the maximum added value Conflict of interest: Authors state no conflict of interest. of 5G in healthcare use cases - with regard to the effectiveness and efficiency of the technology. References 5 Recommendations for [1] Spiekermann & Wegener Stadt- und Regionalforschung, Analyse der Versorgung mit Einrichtung und actions and long-term use of Dienstleistungsangeboten der sozialen Infrastruktur in der Planungsregion Oberpfalz-Nord; 2018 the platform [2] BMVI, 5G-Strategie für Deutschland; 2017 The processing of use cases with the corresponding scenarios is characterized by a high level of application relevance.

Journal

Current Directions in Biomedical Engineering – de Gruyter

Published: Sep 1, 2020

Keywords: rural healthcare; digital healthcare; 5G; integrated care; homecare

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